Contact me

Test your knowledge answers:

1) The RAI User’s Manual on page I-12 states it must meet evidence-based (McGreer) criteria in order to code. It may seem strange to not code it despite treatment and a physician diagnosis, but in this case, it does not meet McGeer’s criteria. The medical record should be documented accordingly, but not coded on the MDS.

2) The SNF ABN 10055 is required when a resident has met the technical elements for Medicare skilled coverage( 3-day QHS plus Medicare days remain in their Medicare benefit) but do not qualify clinically for coverage.

The SNF ABN 10055 may also be given as a courtesy notice for residents admitting without meeting technical requirements.

3) The resident was having a clinical change requiring skilled nursing services from the information provided. Skilled coverage can continue when daily skilled services are required. Also, the Medicare Benefit Policy Manual, chapter 8, section 30.6 states that we should not be so strict in interpreting daily skilled services that we take someone off medically necessary skilled coverage due to missing a day or two of services.

4) RAI User’s Manual, page 2-23:

"An SCSA is required to be performed when a terminally ill resident enrolls in a hospice program (Medicare-certified or State-licensed hospice provider) or changes hospice providers and remains a resident at the nursing home. The ARD must be within 14 days from the effective date of the hospice election (which can be the same or later than the date of the hospice election statement, but not earlier than). An SCSA must be performed regardless of whether an assessment was recently conducted on the resident. This is to ensure a coordinated plan of care between the hospice and nursing home is in place. A Medicare-certified hospice must conduct an assessment at the initiation of its services. This is an appropriate time for the nursing home to evaluate the MDS information to determine if it reflects the current condition of the resident, since the nursing home remains responsible for providing necessary care and services to assist the resident in achieving his/her highest practicable well-being at whatever stage of the disease process the resident is experiencing."

5) Per ICD-10-CM guideline I.C.1.d.4, if a patient is admitted with localized infection and sepsis or severe sepsis, assign the code for the systemic infection (i.e., sepsis) first, followed by a code for the localized infection when sepsis meets the definition of a principal diagnosis. If the patient is admitted with a localized infection and the patient does not develop sepsis or severe sepsis until after the admission, the localized infection is coded first, followed by the appropriate codes for sepsis or severe sepsis, if applicable.