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Test Your Knowledge Answers:

1) The answer to this question is one of the examples in the RAI, page GG-62:

Walk 50 feet with two turns: Resident T walks 50 feet with the therapist providing trunk support. They also require a second helper, the rehabilitation aide, who provides supervision and follows closely behind with a wheelchair for safety. Resident T walks 50 feet with two turns with the assistance of two helpers.

Coding: GG0170J would be coded 01, Dependent. Rationale: Resident T requires two helpers to complete the activity. 

2) This question is specifically for End of Medicare Stay assessments if the discharge location in Item A2105 is 2-12. Did the resident stay in your facility? See pages A-45 and A-46.

In the case of a standalone Medicare Part A PPS Discharge assessment (A0310A = 99, A0310B = 99, A0310F = 99, and A0310H = 1) with the resident staying on the same unit and with the same team of interdisciplinary professionals, code Item A2121 Provision of Current Reconciled Medication List to Subsequent Provider at Discharge as 1, Yes.

In the case of a standalone Medicare Part A PPS Discharge assessment (A0310A = 99, A0310B = 99, A0310F = 99, and A0310H = 1) and the resident is moving to a different unit and/or interdisciplinary team (IDT), code Item A2121 Provision of Current Reconciled Medication List to Subsequent Provider at Discharge based on whether a member of the resident's IDT transferred the resident's current reconciled medication list to the subsequent unit and/or IDT.

3) No regulation prevents you from opening MDSs in the future. Remember, the interview portions of the MDS need to be completed before the ARD passes, so having it open will allow your IDT to complete these tasks, enter them, and sign off on those portions timely. The non-interview portions however should not be completed until after the ARD passes so the entire look-back can be evaluated. 

The ARD sets the unique date that every question on the MDS starts from and establishes the look-back starting point. 

Page A-55: Designates the end of the observation period so that all assessment items refer to the resident's status during the same period of time. The ARD is the last day of the observation period and serves as the reference point for determining the care and services captured on the MDS assessment.

4) Yes, the SCPA resets the schedule just like a SCSA. The next assessment due will be Quarterly #1.

5) No, during the MDS assessment window, the wound had been identified as a pressure ulcer by the physician. Do not modify the MDS. This new wound person has a different idea, but the resident’s physician has identified this wound as a pressure ulcer. The resident’s physician should take a look at the wound and the history of that wound and make his/her determination of the causation of that wound. Changes, if any, would not be retroactive. 

6) Interview the caregivers over those last three days and document their input. Use that information to determine the Usual Performance. 

7) A review of the resident’s status from the previous OBRA assessment would be evaluated against the resident's current status to see if there is a significant change in status from that assessment. There are no specific clinical conditions to review, but the resident’s status as a whole. It needs to be determined if these changes will resolve within 14 days. If not, and the plan of care needs review or revision, then a significant change in status should be completed.

If it is a condition that is not going to resolve in two weeks, such as a CVA or hip fracture, you can then determine to complete the SCSA earlier than the 14-day review. The RAI User’s Manual provides additional guidance on the SCSA on pages 2-24 to 2-31.

A significant change can be combined with a Medicare 5-Day as long as the ARD requirements are met (Days 1-8).

8) No, interviews cannot be copied forward to the next assessment even in the event of an unplanned discharge. If the resident is a Medicare A resident, you may code that the interview cannot be conducted and answer Yes the staff assessment will be done. But this rule ONLY applies to the BIMS. You may need to dash the other interviews if they were not conducted before the discharge.

9) There has been an MDS Errata document that changes the recommendation to go to the staff assessment if D0150A1 and D0150B1 are both coded 9 or if there were 3 frequencies that were blank.  Here is the updated language (see attached errata document):

"D0100 serves as a gateway item for the Resident Mood Interview (PHQ-2 to 9©) and D0500, Staff Assessment of Resident Mood (PHQ-9-OV©). The assessor will complete the Staff Assessment only when D0100 is coded 0, No.
The assessor does not complete the Staff Assessment based on resident performance during the Resident Mood Interview."

"Resident refusal or unwillingness to participate in the interview would result in Item D0100 being coded 1, Yes, and code 9, No response being entered in Column 1. Symptom Presence. Assessors should proceed to Item D0700, Social Isolation in the case of resident refusal or unwillingness to participate." 

On page D-5, in item 10 under "Steps for Assessment," language was revised to add "and skip to D0700, Social Isolation" to provide additional skip pattern guidance.
10. Determine whether to ask the remaining seven questions (D0150C to D0150I) of the Resident Mood Interview (PHQ-2 to 9©). Whether or not further evaluation of a resident's mood is needed depends on the resident's responses to the first
two questions (D0150A and D0150B) of the Resident Mood Interview.
• If both D0150A1 and D0150B1 are coded 9, OR both D0150A2 and D0150B2 are coded 0 or 1, end the PHQ interview; otherwise continue.
- If both D0150A1 and D0150B1 are coded 9, leave D0150A2 and D0150B2 blank, then end the PHQ-2©, and leave D0160, Total Severity Score blank, and skip to D0700, Social Isolation.
- If both D0150A2 and D0150B2 are coded 0 or 1, then end the PHQ-2© and enter the total score from D0150A2 and D0150B2 in D0160, Total Severity Score.
• For all other scenarios, proceed to ask the remaining seven questions (D0150C to D0150I of the PHQ-9©) and complete D0160, Total Severity Score. 

On page D-6, in bullet 2 under "Coding Tips and Special Populations," language was revised to add "and skip to D0700, Social Isolation" to provide additional skip pattern guidance.
• If both D0150A1 and D0150B1 are coded 9, leave D0150A2 and D0150B2 blank, then end the PHQ-2©, and leave D0160, Total Severity Score blank, and skip to D0700, Social Isolation.

MDS 3.0 RAI User’s Manual (v1.18.11R) Errata (v2) Effective October 01, 2023

10) Yes, it would be coded as long as the resident was not admitted to the hospital as an inpatient for the infusion and returned to the facility within 24 hours if not an inpatient. 

11) If asking whether you can code isolation when she was only isolated 3 of the 7 days in the look-back, the answer is YES. This is if all 4 requirements for coding isolation were met (COVID-19 meets the definition of an epidemiologically significant pathogen).  This MDS item can be coded if the 4 requirements were met even one day during the MDS look-back (Look-back for this item is 14 days or since admission if admission was less than 14 days from the ARD.

Code for "single room isolation" only when all of the following conditions are met:

1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.

2. Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.

3. The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.

4. The resident must remain in their room. This requires that all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.). 

12) Since this isn’t a discharge, a Death in Facility tracking form on the date the resident died would be completed. CMS states in the RAI User’s Manual, chapter 2 on page 2-10:

“Death in Facility refers to when the resident dies in the facility or dies while on a leave of absence (LOA) (see LOA definition). The facility must complete a Death in-facility tracking record. No Discharge assessment is required.”

13) The 3-day window for Admission MDSs would be the Admission date and the following 2 days (12-08-23 through 12-10-23). 

14) If there is a nutritional or hydration benefit to the resident by receiving the additional fluids, it would be captured in section K of the MDS. 

15) The pain interview must be completed within the 5-day look-back from the ARD. It is not the usual 7 days, it is 5 days for the pain interview. See the RAI User's Manual, Chapter 3, Section J, page J-9:

Steps for Assessment
1. Ask the resident: "Have you had pain or hurting at any time in the last 5 days?"
Coding Instructions for J0300, Pain Presence
Code for the presence or absence of pain regardless of pain management efforts in the last 5 days.
• Code 0, no: if the resident responds "no" to having any pain or hurting in the last 5 days. Code 0, no: even if the reason for no pain is that the resident received pain management interventions. If coded 0, the pain interview is complete. Skip to Shortness of Breath item (J1100).
• Code 1, yes: if the resident responds "yes" to having any pain or hurting in the last 5 days. If coded 1, proceed to the Pain Assessment Interview.

16) Per the guidance on pages J-36 through J-37, the choices are 0. None, 1. One, 2. Two or more, for falls with no injury, falls with minor injuries, falls with major injuries. 

Determine the number of falls that occurred since admission/entry or reentry or prior assessment (OBRA or Scheduled PPS) and code the level of fall-related injury for each. Code each fall only once. If the resident has multiple injuries in a single fall, code the fall for the highest level of injury.