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Test Your Knowledge Answers:

1) For I5600, a physician/NP/PA needs to document “malnutrition,” “at risk for malnutrition,” or some other diagnostic statement that translates to an ICD-10 code from E40-E46 except for E45, which is a sequelae code.

2) If the resident does not return to your nursing home by 11:59 pm tonight, it is not an interrupted stay. The Part A PPS Discharge MDS would be combined with the OBRA Discharge MDS.

3) Medications are classified by drug class. Aspirin and Plavix are technically considered antiplatelet medications, so they are not coded on the MDS. Eliquis is an anticoagulant, so it should be coded on the MDS.

4) There are no specific Joint Commission standards that prohibit the use of fans. While fans may be used for additional comfort of the patient, such as those with respiratory distress or post cardiac surgery, they may indicate to surveyors that a temperature control or ventilation problem exists, as described by EC.02.05.01. Space temperature issues can impact equipment, patient testing results, and overall patient care. This concern usually arises after adding equipment or use of the space without increasing the capability of space cooling/ventilation. The organization should perform a risk assessment per EC.02.01.01 that includes the most appropriate persons available to the organization.

Examples of assessment concerns could include:

• Risks pertinent to the needs of the patient;

• Ventilation and/or temperature concerns for equipment;

• Airborne particles/contamination that may impact patient care, procedure/treatment processes or equipment operation;

• Maintaining the cleanliness of fan blades/housing;

• Possible tripping hazard(s) created by cords.

Infection control should be a key element in the assessment process. The survey process would evaluate the risk assessment for effectiveness and validate proper implementation of the resulting policy/practice. Adjustments to the implemented process are to be made as needed. (Question was presented to APIC)

5) The RAI User's Manual is the ultimate authority for MDS coding. Car transfers are a specific functional mobility item that must be assessed. This item can be assessed using a car or a car simulator that contains a passenger cabin. You cannot assume the coding for car transfers based on other transfer activities. It is correct, the code of 10 is used when no car or car simulator is available.

6) Yes, if the wound is unstageable due to slough/eschar with daily treatment.