Waiving nursing requirement for home infusion therapy

Often during an audit, we see that a patient is performing home infusion therapy on their own — without nursing care — but the required Certificate of Medical Necessity documentation doesn’t follow the necessary guidelines. To waive the nursing requirement, the following must apply and be documented:

• The patient considers himself or herself independent and no longer wants or requires nursing visits.
• Documentation on the CMN states:
• The nursing visit requirement was explained to the family or caregiver.
• The patient or caregiver is capable and willing to provide the infusion-related care.
• The patient or caregiver is aware that nursing is available on an as-needed basis.
• The patient’s physician signs the CMN within the required 90 days, as stated in the guidelines, of the criteria above, acknowledging his or her agreement.

All future CMNs will require the same components, and CMNs must be renewed every 120 days. If a CMN doesn’t have all the necessary components, a sanction equivalent to the cost of one nursing visit will be applied to the S code every seven days that nursing wasn’t provided.

None of the information included herein is intended to be legal advice and as such it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.