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A1) Yes, the Part A PPS Discharge MUST be completed when Medicare benefits exhausted. The Part A PPS discharge MDS must be completed every time Medicare ends, except when the resident dies while on Medicare coverage. 

A2) The COVID-19 Vaccine item, O0350, is asking if the vaccine is up to date per CDC guidance. It does not matter where the vaccine was received (in the facility or outside the facility). This question should only be dashed if your team did not assess the COVID-19 status. If you assessed the vaccine status, code Yes if it is up to date at the time of the ARD based on current CDC guidance; if it is not up to date, code No. 

A3) Yes. Part of the confusion can come from different sections of the MDS utilizing different coding guidance. In section J, you are coding any medication that is being used for pain prevention or pain relief, regardless of the classification of the drug. Section N is all about the drug classification and NOT the reason for the drug’s use.

From p. J-1 of the RAI User’s Manual:

DEFINITION

PAIN MEDICATION REGIMEN

Pharmacological agent(s) prescribed to relieve or prevent the recurrence of pain. Include all medications used for pain management by any route and any frequency during the look-back period. Include oral, transcutaneous, subcutaneous, intramuscular, rectal, intravenous injections, or intraspinal delivery. This item does not include medications that primarily target treatment of the underlying condition, such as chemotherapy or steroids, although such treatments may lead to pain reduction.