PRN Orders
Medicare
Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.2.2)
Orders for services as needed (PRN) must be accompanied by a description of the patient’s medical signs and symptoms that would initiate a visit and a specific limit on the number of those visits to be made before an additional physician order would need to be obtained.
When a PRN visit is made, the date and reason for the visit should be documented in the medical record.
When an extra visit is billed and the plan of care contains open ended and/or unqualified PRN orders, an additional physician order must be obtained for the visit. If the agency does not have a signed interim order for the visit, the visit may be denied.
Example 1: A beneficiary with a Foley catheter requires monthly catheter changes. The physician orders "Two (2) PRN visits per month for problems with the Foley catheter including blockage and/or leakage around the catheter."
Visits are allowed because the physician specifically quantified the specific number of visits and qualified the visits to a specific need.
Example 2: A beneficiary with a Foley catheter requires monthly catheter changes. The physician orders include "PRN visits."
The orders are not quantified as to the number of visits or qualified as to a specific potential need of the beneficiary, no PRN visits are allowed.
Example 3: “Skilled nurse 1-2x/week for 2 weeks PRN for pain rated greater than 8 on the 0 to 10 pain scale.”
This order is for as needed visits 1 to 2 times per week for 2 weeks for a specific symptom with a specific period of time. If the signs and symptoms indicate a need for more visits, a new physician order would need to be obtained.
Updated: 07.31.15
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