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Test your knowledge answers:

1) In situations where one or more medications that the patient is currently taking and are listed on the Plan of Care are not available to the patient, preventing the patient from being able to demonstrate their ability to manage oral or injectable medications, the assessing clinician could code using assessment strategies other than direct observation. The assessing clinician would rely on their assessment of the complexity of the patient’s overall drug regimen, as well as patient characteristics, including cognitive status, vision, strength, manual dexterity and general mobility, along with any other relevant barriers, and use clinical judgment to determine the patient’s current ability. In selecting a code, the clinician may use information gathered by report and/or observation, including details about when and how the patient accesses and administers their medications.

2) Ascending and descending stairs does not have to occur sequentially or during one session. If the assessment of going up and down stairs, by any safe means, occurs sequentially, the patient may take a rest break between ascending and descending the 4 steps or 12 steps.

While a patient may take a break between ascending or descending the 4 steps or 12 steps, once they start the activity, they must be able to ascend (or descend) all the steps, by any safe means without taking more than a brief rest break in order to consider the stair activity completed.

3) Yes, to satisfy the intent of the Transfer of Health Information to Provider quality measure, the guidance related to use of RFA 7 in the unique circumstances referenced is being modified. Effective immediately, do not use RFA 7 - Transferred to an inpatient facility - patient discharged from your agency when a patient dies less than 24 hours after being admitted to an inpatient facility, or when a patient dies in the emergency room (ER), or when a patient dies in outpatient surgery or in the care of the recovery room after outpatient surgery. Effectively immediately, use RFA 8 - Death at home for these circumstances.

Continue to use RFA 7 - Transferred to an inpatient facility - patient discharged from your agency when a patient is transferred from your agency for a qualifying inpatient stay and return to your agency is not expected. A qualifying inpatient stay is defined as a patient being admitted to an inpatient facility for 24 hours or more for reasons other than diagnostic testing.

4) If a pressure ulcer/injury was closed with a skin graft or flap, the surgical wound healed, and another pressure ulcer/injury forms in the same anatomical location due to pressure, then this would be considered a pressure ulcer/injury. Note it should be staged at the highest stage the pressure ulcer/injury was prior to closure, unless currently presenting at a higher stage or unstageable.