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Test Your Knowledge Answers:

1) Code 9 when there are more than 9 ulcers at any stage. 

Refer to Chapter 3, page 3-5 of the RAI User’s Manual:

"When completing the MDS 3.0, there are some items that require a count or measurement, however, there are instances where the actual results of the count or measurement are greater than the number of available boxes. For example, number of pressure ulcers, or weight. When the result of a count or measurement is greater than the number of available boxes, facilities are instructed to maximize the count/measurement by placing a “9” in each box (e.g., for item K0200B, if the weight was 1010 lbs., you would enter 999 in the available boxes). Even though the number is not exact, the facility should document the correct number in the resident’s medical record and ensure that an appropriate plan of care is completed that addresses the additional counts/measurements."

2) Ibrance is a kinase inhibitor used to treat breast cancer, but it is not considered a chemotherapeutic agent and would not be captured in O0110. 

The RAI User’s Manual, page O-3, clarifies:

“Hormonal and other agents administered to prevent the recurrence or slow the growth of cancer should not be coded in this item, as they are not considered chemotherapy for the purpose of coding the MDS.” 

3) Aftercare Z codes cannot be used for injuries like fractures. Each fracture would need to be coded separately and determine which requires the most skilled care to choose as your primary diagnosis. 

4) Medicare coverage does not need to stop because a resident is out of the facility over midnight or more than 24 hours. It is an LOA day and the day would be billed as noncovered, but no MDS is required and Medicare does not need to end  

See the Medicare Benefit Policy Manual, Chapter 8, Section 30.7.3:

The "practical matter" criterion should never be interpreted so strictly that it results in the automatic denial of coverage for patients who have been meeting all of the SNF level of care requirements, but who have occasion to be away from the SNF for a brief period. While most beneficiaries requiring an SNF level of care find that they are unable to leave the facility, the fact that a patient is granted an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in an SNF for the receipt of required skilled care. Where frequent or prolonged periods away from the SNF become possible, the A/B MAC (A) may question whether the patient's care can, as a practical matter, only be furnished on an inpatient basis in an SNF. Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences. (See the Medicare Benefit Policy Manual, Chapter 3, "Duration of Covered Inpatient Services," §20.1.2, for counting inpatient days during a leave of absence.)