Which of the following is a Medicare-approved indication for home parenteral nutrition?

• A. Long-term loss of gastrointestinal function
• B. End-stage renal disease
• C. Delayed gastric emptying
• D. Supplement to enteral nutrition

Answer: (A)

Medicare covers home parenteral nutrition when a patient has irreversible intestinal failure and cannot meet nutritional needs through the GI tract. In this situation, the gut can’t absorb or metabolize enough nutrients, so nutrition must be provided intravenously to maintain weight and proper metabolism.

The scenario of a long-term loss of gastrointestinal function is exactly this situation—the gut is nonfunctional enough that oral or enteral feeding can’t meet daily needs, making home parenteral nutrition appropriate. In contrast, end-stage renal disease is managed with dialysis and renal-specific nutrition, not PN. Delayed gastric emptying is a motility issue that can affect intake but does not by itself represent irreversible gut failure requiring IV nutrition. Using parenteral nutrition as a supplement to enteral nutrition implies PN is added because EN alone doesn’t meet needs, which is not the Medicare indication for home PN unless there is irreversible intestinal failure; PN is used when the GI tract cannot meet nutritional requirements.

So the correct choice reflects irreversible GI dysfunction that prevents adequate nutrition through the gut, necessitating home parenteral support.