Would the diagnosis of partial small bowel obstruction alone qualify a person for HPN under present Medicare guidelines? Why?

• A. Yes, because any obstruction qualifies
• B. Only if radiology confirms obstruction
• C. Maybe, if patient cannot swallow at all
• D. No, because guidelines require a nonfunctional GI tract

Answer: (D)

The key idea is intestinal failure: home parenteral nutrition is reserved for a nonfunctional GI tract that cannot absorb enough nutrients, fluids, and electrolytes to meet needs. A partial small bowel obstruction does not by itself make the gut nonfunctional; there can still be some luminal flow and residual absorptive capacity, and the obstruction is often a reversible issue with treatment. Therefore, merely having a partial obstruction does not meet the Medicare criterion for long-term parenteral nutrition. The guidelines require evidence of irreversible or persistent intestinal failure, not just an obstruction. Radiology showing obstruction isn’t enough on its own, and inability to swallow is a separate issue unrelated to the gut’s absorptive capacity determining PN need.