MDS Broadcast February 2026 - Questions and Answers

MDS Broadcast February 2026

Scenario One:

A provider reached out as they discovered that over the past several years, an LPN had signed/dated Z0500. The same LPN also signed/dated V0200B, Signature of RN Coordinator for CAA Process, and Date Signed on comprehensive MDSs. An audit was conducted of all MDS assessments completed during this person’s employment and found 64 assessments that were inaccurately signed by the LPN.

The facility completed modifications on all 64 assessments to correct the signature to that of an RN. They did not change any of the dates at V0200B or Z0500B. Both items still have the original date the LPN signed.

Resolution:

In this scenario, the date that the RN assessment coordinator has signed at Z0500 and V0200B should be reflected on the corrected MDS assessments. Please refer the provider to the Coding Instructions in the MDS 3.0 RAI User’s Manual on pg. Z-7, which states:

· For Z0500B, use the actual date that the MDS was completed, reviewed, and signed as complete by the RN assessment coordinator. This date must be equal to the latest date at Z0400 or later than the date(s) at Z0400, which documents when portions of the assessment information were completed by assessment team members.

· If, for some reason, the MDS cannot be signed by the RN assessment coordinator on the date it is completed, the RN assessment coordinator should use the actual date that it is signed.

Since the dates in V0200B and Z0500B were not modified to reflect the actual dates, the RN certified the CAA reviews as complete and/or reviewed the assessments and certified they were complete, the modifications were completed incorrectly. The assessments should be modified again to reflect the actual dates the RN signed V0200B and/or Z0500B.

Scenario 2:

For O0110E1, if a resident no longer has a trach but still has an open stoma related to the tracheostomy, can the care of the stoma be coded here?

Resolution:

As long as the tracheostomy has not healed, it can be coded as a surgical wound in M1200F. In addition, if the staff and/or the resident is providing care, you may also code tracheostomy care in O0110E, even if there is no cannula and/or suctioning occurring.

Scenario 3:

A resident was on Rexulti 2mg. The resident was started on Risperidone, and the provider reduced the Rexulti dose from 2mg to 1mg in the context of starting Risperidone.

The RAI manual states:

"Do not count as a GDR an antipsychotic medication reduction performed for the purpose of switching the resident from one antipsychotic medication to another."

At this moment, the resident will be on both Rexulti and Risperidone. Thus, this was not "switching the resident from one antipsychotic medication to another."

Would the reduction of Rexulti be considered a GDR?

Resolution:

The provider notes that the Rexulti was decreased due to starting risperidone. While the resident is currently on both medications, the Rexulti was decreased when the risperidone began, rather than the resident receiving both medications and one of them being titrated. The following coding tip applies in this scenario: “Do not count as a GDR an antipsychotic medication reduction performed for the purpose of switching the resident from one antipsychotic medication to another” (pg. N-16 of the MDS 3.0 RAI User’s Manual v1.20.1), and the provider should code N0450B, Has a gradual dose reduction (GDR) been attempted? as 0, No.

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