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Test your knowledge answers:

1) In order to use code R27.8 "Other - Lack of Coordination", the physician must have documented the very specific coordination problem that does not have an ICD-10-CM code with that level of specificity. This code is the polar opposite of unspecified lack of coordination.

2) The Care Area Assessments must all be completed before V0200B can be signed for completion. If the MDS is not required because the resident discharged before the MDS was due, you could close it as incomplete. Or if you prefer to complete the MDS, complete all triggered Care Area Assessments. You can then date the care plan completion date with the same date as the CAA completion date; however, the CAAs must actually be completed in order to do this.

3) Typically, you want to address discharge goals based upon what therapy has for their discharge goals. Therapy typically does not address every ADL - they pay extra attention to the ones that impact the PDPM RUG.

We are only required to code one goal. The rest can be dashed without issue. This is an exception to the dashing rule. Nothing is negatively affected by these dashes. Keep in mind, every goal you do choose needs to be care planned. So you may only choose one (or a few) if you feel they are particularly relevant to the resident.

4) Behavior coding is not affected by the resident’s cognitive level. The RAI User’s Manual states that we code the actual episodes of behavior not the intent.

Chapter 3, Section E page E-1:

"This section focuses on the resident’s actions, not the intent of his or her behavior. Because of their interactions with residents, staff may have become used to the behavior and may underreport or minimize the resident’s behavior by presuming intent (e.g., “Mr. A. doesn’t really mean to hurt anyone. He’s just frightened.)” Resident intent should not be taken into account when coding for items in this section."

5) Floor nurses may be trained to complete Section GG documentation daily on days 1-3 by gathering functional information for Section GG based on what they see, not by what the nurse determines to be a resident's usual performance. Additionally, if the resident is on therapy caseload, therapists are also trained to complete a GG assessment during the first 3 days. MDS Coordinators should consistently review the "MDS Final GG” assessment, to include all therapy and nursing GG documentation, discuss findings with the IDT, and assemble the information to determine “usual performance”. The MDS Final can then become the supporting document for what is coded on the MDS.

Until next time, have a great March!