Contact Information

Wendy Castro

MDS Training Coordinator RAC-CT

 wendy.castro@state.co.us

cdphe_mds_colorado@state.co.us

303-692-2854

Test Your Knowledge Answers:

1) Shower/bathe self DOES go towards and impact the APU if dashed. Tub/shower transfers do not. If no bath was scheduled during the 3-day window, it must be dashed. Find a way to get the bath done during the 3-day window. Can be a bath, shower, or full body sponge bath--head to toe not including hair or back. Don't forget to wash the toes. 

2) You can only code the bed bath if it is a total bed bath, not a partial.

3) If the resident does not mobilize with a traditional wheelchair (manual or electric) then answer the gateway question in GG Q3 or Q5 depending on the type of assessment as NO. The wheelchair items will then be greyed out. 

4)  If a resident's usual performance can be determined from assessments on one or two days that should be fine. A total of 3 days has been provided to complete the assessments, but a separate assessment is not required each day. Keep in mind, that a resident's performance on Admission should be prior to benefiting from services. If the resident has already improved by day 3, then only include assessments from days one and two in the determination of admission performance. 

5) You cannot submit a 5-day PPS MDS for a resident whose payer is anything other than traditional Medicare A. The updated RAI User's manual states that we are not to create a 5-day PPS MDS for non-traditional Medicare A payers. If your software has an alternative assessment set up to capture a HIPPS code that will not transmit, that is what you should use. 

6) All Aspirin (no matter the dose) has the pharmacological classification as antiplatelet. 

7) You need a 5-day to get paid at a PDPM rate for those first few days. If the 5-day had been created and the ARD set on the item set prior to his death, then adjust the ARD of the 5-day to the date of death and complete. If the 5-day had not yet been created prior to the resident’s death, it cannot be completed now, and the days would be billed at the default rate. 

8) The intent of Column B is to capture services once the resident becomes your resident and within the last 14 days. So, they would enter your facility, which makes them “while a resident,” and then if the treatment was received in the 14-day window “while a resident,” code it. 

9) The risk for malnutrition is in Section I, so the steps for assessment and coding instructions for Section I apply. 

You need the physician or physician extender to make a diagnosis and document it within the 60-day look-back period that ends on the ARD. A diagnosis made by a physician or physician extender after the ARD doesn’t meet this requirement. A recommendation or request by non-physician staff doesn’t meet the requirement either. Only code this as an active diagnosis if the documentation supports this is active during the look-back period.

10) Yes, every MDS in error should be modified up to two years old.

11) Only the 5-day PPS MDS and Part A PPS Discharge MDS responses impact the APU.

12) This is the definition in the Glossary section of the RAI. Remember, to count the minutes it is only the time the nurse spent with the resident for the treatment. 

Respiratory Therapy-

Services that are provided by a qualified professional (respiratory therapists, respiratory nurse). Respiratory therapy services are for the assessment, treatment, and monitoring of patients with deficiencies or abnormalities of pulmonary function. Respiratory therapy services include coughing, deep breathing, nebulizer treatments, assessing breath sounds and mechanical ventilation, etc., which must be provided by a respiratory therapist or trained respiratory nurse. A respiratory nurse must be proficient in the modalities listed above either through formal nursing or specific training and may deliver these modalities as allowed under the State Nurse Practice Act and under applicable state laws.

13) Heparin flushes are not coded as an IV medication and are also not coded as an anticoagulant medication in Section N. 

14) If the resident's ostomy dressing meets the definition it can be coded as a non-surgical dressing. No, there is no other MDS item except Section H if it is an excretory ostomy. 

15) If the resident is discharged home with home health, the “discharge to” item would be coded 12, not 01. Community. The medication reconciliation would be given to the provider (home health agency in this example). While it would be appropriate to also give the reconciliation list to the resident, the MDS item and Quality Measure would be focused on transferring the health information to the next provider (home health agency). The MDS item about medication reconciliation to the resident would not be answered. (It would only be answered if the discharge was to 01. Community or 99. Other). 

16) Refer to coding tips on pages A45-A46 of the RAI User’s Manual:

• 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 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 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.

17) The changes to the MDS also necessitate changes to forms that are completed on surveys. Specifically, fields on the CMS-672 form can no longer be completed due to the removal of Section G from the MDS. Also, CMS and surveyors no longer use these MDS-based fields on the CMS-672 form as part of the survey process. Therefore, effective September 29, 2023 facilities are no longer required to complete these fields (F79 – F145) and surveyors are no longer required to enter this information (fields F79 – 93) in the survey system. The census information (fields F75-F78), the ombudsman information (fields F146 and F147), and the medication error rate (field F148) should still be completed. On October 22, the census, medication error rate, and ombudsman information fields will be relocated to the form CMS-671, and the CMS-672 form will be removed. This change will help streamline the survey process for surveyors and facilities. We are aware that researchers and other stakeholders may use CMS-672 data, so we will be exploring other ways to make MDS-based data publicly available to all stakeholders through a separate mechanism. 

18) If the resident's sleeping position is not flat or nearly flat due to a medical condition, code 88 for those items that are impacted by the need to lay flat to assess. 

19) MRSA in the nares usually means that the resident is colonized with MRSA.  It is not a reason to isolate the resident.  It would not meet the requirements for coding strict isolation. 

20) The RAI User's Manual does not exclude any type of chair when transferring from bed to chair. 

212) If the resident discharged AMA, it would be coded as an unplanned discharge. 

22) Resident interviews (pain, PHQ-2 to 9, and BIMS) are now required on Part A PPS MDSs. It was one of the many changes that began on 10/1/2023. 

23) The complication of the joint prosthesis--infected internal knee prosthesis could be coded in I8000 and potentially in I0020B if that is the resident's primary reason for skilled care. The wound itself is not infected from the information provided, so it would not be coded as wound infection in Section I, item I2500. 

24) Yes, if the injection was given in the facility, it would be coded as given in the facility. 

25) See the RAI User's Manual, Chapter 3, Section A, 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 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 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.