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Did you know answers

1) No, the surveillance criteria for a UTI diagnosis made before admission would not be applied. The RAI clarifies on page I-14 that the surveillance criteria are not necessary when the diagnosis was made before admission, entry, or reentry to the SNF. 

For these situations, you do not need to meet the #1 criteria: It was determined that the resident had a UTI using evidence-based criteria such as McGeer, NHSN, or Loeb in the last 30 days. 

You only have to meet the #2 criteria: A physician documented UTI diagnosis (or by a nurse practitioner, physician assistant, or clinical nurse specialist if allowable under state licensure laws) in the last 30 days.

Page: I-14: 

If the diagnosis of UTI was made prior to the resident's admission, entry, or reentry into the facility, it is not necessary to obtain or evaluate the evidence-based criteria used to make the diagnosis in the prior setting. A documented physician diagnosis of UTI before admission is acceptable. This information may be included in the hospital transfer summary or other paperwork.

For coding the MDS, you do not use surveillance criteria when the diagnosis was made before admission. It's not optional. So, even if the UTI did not meet McGeers, you would still code it on the MDS since the diagnosis was made before admission.

2) Because this pressure ulcer/injury has not been numerically stageable at any point in the resident's stay (i.e., the resident was admitted with an unstageable ulcer due to deep tissue injury that evolved to a pressure ulcer/injury that was unstageable due to slough or eschar), the unstageable pressure ulcer/injury due to slough or eschar continues to be considered present on admission.

3) The long-stay look-back scan period for each resident needs to be identified. First, pinpoint the current episode of care and the most recent qualifying RFA; this is considered the target assessment. Then count back 275 days from the target date of the target assessment. All qualifying RFAs within this look-back are scanned for the measure condition. The most recent target assessment ARD looks at the target date of the assessment that captured the fall, not the date the fall occurred. This results in the look-back period, and depending on this date, it will continue to trigger.

If the above explanation is too vague, I have included a link to a document with a more detailed explanation.

Falls QM Explained