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Tube feeding covered by Medicare?
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Picture of UVA
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My mother has a PEG tube through which she receives almost all of her nutritional needs.
She had the tube placed in Jan. She used her 100 days of Medicare coverage and now needs to be in long term care because of the tube. Otherwise she could be in an assisted living for persons with dementia. No ethical issues here, she is ambulatory, conversant and usually pleasant. She just doesn't have the inclination to eat enough to sustain life. She will sometimes put food in her mouth and it stays there until she spits it out. She does occassionally eat a little. They have estimated about 15% on average.

To my knowledge she has never been diagnosed with difficulty swallowing. I am trying to have Medicare Part B pay for the tube feedings as the feeding itself is expensive and the equipment including a pump.

Has anyone ever had Medicare Part B pay for tube feedings? Do you know what the requirements are? The provider rejected the Medicare coverage but I have told them to submit info to Medicare and let Medicare reject it. The provider was focusing on the lack of dysphagia. It is the dementia that causes my mother not to want to eat or to chew and swallow. I am hoping that is enough.
 
Posts: 19 | Location: Southeastern PA | Registered: January 08, 2002Report This Post
Senior Member
Picture of Jim Kallio
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NINDS Swallowing Disorders Information Page


quote:
What are Swallowing Disorders?
Swallowing disorders - defined as difficulty in passing food or liquid from the mouth to the stomach - occur in all age groups, but especially in the elderly. The disorders can occur at any stage of the normal swallowing process, in which food and liquid move from the mouth, through the pharynx, into the esophagus, and finally, into the stomach. The disorders are common in individuals with degenerative neurological disorders such as amyotrophic lateral sclerosis (ALS), postpolio syndrome, myasthenia gravis, multiple sclerosis, and Parkinson's disease, and may be the first symptom of the disease. They may also occur after sudden neurological damage as in stroke, or head or spinal cord injury, or indicate other problems, such as the presence of cancer or heart problems. People with swallowing disorders may suffer from weight loss or dehydration and may be at risk for developing pneumonia. Some individuals notice that the disorders get worse at times of stress or excitement.



Ok--I have a question here--to clarify--

She's never been diagnosed with dysphagia--why the peg tube then?--So she doesn't starve to death. The dementia is causing the dysphagia?

It sounds like there may be a need to have a speech therapist do a swallowing evaluation--and then let the provider and Medicare B work it out. From what I read on the NINDS site--her problem is due to brain damage. Alas--the addiional problem exists with ICD-9 diagnostic codes and getting the diagnosis to be spelled out as a physical problem and not a mental problem.

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Use today wisely,
It's the only one we get.

Oh, for so short a time,
we are on loan to each other.

Jim
 
Posts: 1644 | Location: Virginia | Registered: May 26, 2002Report This Post
Senior Member
Picture of sechang
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Tube feeding and Medicare: This opinion was written in 1999, and there are very likely new undates since then.

http://www.clinnutr.org/news/hfca514.html
 
Posts: 1510 | Location: Danville, California | Registered: February 05, 2003Report This Post
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Picture of UVA
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Thank you for your responses. She is awake and alert and cannot be forced to eat. She will not open her mouth if she doesn't want to.
She did this for too long and a feeding tube was the only solution. Because I viewed this as caused by her dementia I could not let her starve herself.

It is difficult to get a good evaluation. She was evaluated twice by a speech therapist. In the hospital and in the nursing home. I had not been told that she actually has difficulty swallowing when she was able to swallow but she does not always swallow or chew her food. The ST tried about 6 different times to get her to drink something and she wouldn't.
Last night I visited her at 7 oclock and she still had a piece of food in her mouth from dinner. I finally got her to spit it out.
We tried pureed foods but she would not eat them.
 
Posts: 19 | Location: Southeastern PA | Registered: January 08, 2002Report This Post
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