Harmony Healthcare Blog

MDS 3.0 Updates Effective October 1, 2018: Question and Answer (Part II of IV)

Posted by Sally Fecto on Tue, Sep 25, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Be Prepared sign with sky background-1As a continuation of the four-part MDS blog series, the below questions/answers add more insight into the design and intent of the MDS and its relation to the care planning process. The Team at Harmony Healthcare International (HHI) takes pride in our “we don’t know, what we don’t know” culture that fosters an environment for continuous knowledge seeking. The more educated the healthcare professional, the better the care that is rendered the patient. 

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“The more educated the healthcare professional, the better the care that is  rendered the patient.”

Question and Answer with Sally Fecto Sr. VP Field Operations Harmony Healthcare International (HHI) 

  1. Would CHF be included under cardiopulmonary conditions?

    Review the clinical picture to make the determination and assignment of the resident’s primary medical condition associated with admission to the facility.

    For example, Code 12- Debility, includes cardiorespiratory conditions for the resident’s primary medical condition category is debility or a cardiorespiratory condition such as chronic obstructive pulmonary disease (COPD), asthma, and other malaise and fatigue or Code 13- Medically Complex Conditions, applies for Medically Complex conditions and may be appropriate if the resident’s primary medical condition category is a medically complex condition.  Examples include diabetes, pneumonia, chronic kidney disease, open wounds, pressure ulcer/injury, infection, and disorders of fluid, electrolyte, and acid-base balance.  Determine which category is more reflective of the diagnosis associated with the need for services. 
  1. Does the sequence of Primary Dx affect reimbursement? if patient has both Fracture and UTI, if we used Fracture and not UTI, would that mean higher reimbursement?

    Not currently, but accurate identification of the primary medical condition is important and PDPM impacts proper classification.  
  1. If the primary condition is coded in I0020 (primary medical condition) does a corresponding ICD-10 code need to be added to I8000 (active diagnoses)?

    I0020 identifies the resident’s primary medical condition category. I8000 identifies additional active diagnoses for a disease or condition not specifically listed in Section I:  I4900- I7900, active diagnoses.  Enter the diagnosis and ICD code in item I8000.  These items are asking different questions: primary medical condition and active diagnoses, present in the last 7 days and supported by physician in the record within the last 60 days.  I0020 identify general conditions.  If the diagnosis meets Section I8000 coding criteria, it may be further defined in I8000. 
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  1. What is Microclimate?

    Microclimate is the climate of a very small or restricted area, especially when this differs from the climate of the surrounding area. Microclimate is referred to by the National Pressure Ulcer Advisory Panel (NPUAP) as the local temperature and moisture level at the body/support surface interface. 

    Microclimate has a role in pressure injuries, considering the effects of perspiration, drainage or incontinence.  Microclimate is an important consideration for assessing pressure ulcer/injury risk factors.  Moisture increases friction and sheer.   Elders often have a reduced ability to dissipate heat with changes in blood vessels, temperature and skin moisture.  Moisture increases tissue deformation and maceration which increases risk for pressure ulcer/injury formation. 
  1. Is Section GG for Medicare Part A only? Do you know if the intention is for Section G to be removed and Section GG take its place for all residents?

    Yes, Section GG is for Medicare Part A MDS Assessments, only.  Section G will continue to be required on all assessments and remains the ADL end-splits for Case Mix RUGs classification and for CAA of ADL Functional Rehabilitation Potential.  ADL scoring in PDPM will shift from Section G to Section GG for the end-splits.  This is only for Medicare classification. 
  1. Will the unstageable wound d/t non-removable dressing/device identified after the dressing/device is removed count against our quality measure?

    Yes, the unstageable wound due to a non-removable dressing may reflect negatively on the facility quality measure as “house acquired” if not supported and coded as present on admission on the 5-Day MDS.  Documentation must be present to indicate that there is an existing pressure ulcer/injury covered by a non-removable dressing/device in admission documentation.  If the pressure injury/ulcer is identified only after the non-removable device is removed, it will reflect as not present on admission with a negative QM impact.  Carefully review all referral information and ask the resident and family if there are any concerns identified under the non-reviewable device.
  1. Is it true that Medicare/Medicaid will no longer pay for Primary Diagnosis of Dementia and Alzheimer’s as of Oct. 1st?

    Medicare does not pay for any specific diagnosis. Rather, Medicare covers for the skilled conditions that require the skills, knowledge and judgement of healthcare professionals. The diagnosis is not the skill.  It is the medically necessary, daily skilled services that supports coverage in a SNF. 
  1. For Section GG: How may discharge goals are you required to complete and how many do you recommend?

    For the SNF Quality Reporting Program (QRP), a minimum of one self-care or mobility discharge goal must be coded. However, facilities may choose to complete more than one self-care or mobility discharge goal.  The discharge goal may be the same, higher or lower than the 5-Day Functional Assessment due to clinical considerations.  Set as many goals that are reflected as reasonable and attainable based on the Plan of Care. 
  1. How do we set the Assessment Reference Date (ARD) date for the five-day assessment and do we have grace days?

    Assessment Reference Date (ARD) selection does not change in October.  The 5-Day may be set using days 1-8.  The ARD must be set within the assessment window.  Confirm the ARD selection by day 9.  That is, the ARD may not be selected or changed on day 9 and would result in AAA days as a late assessment. 
  2. In Section I0020, where it says to describe the primary reason for admission; is this saying why the resident must live in a nursing home and cannot go home? Would this be the hospital admitting diagnosis?

    This is the primary reason for admission to the nursing home and services required.  The Primary Diagnosis represents the primary medical condition that resident’s admission and influences the resident’s functional outcomes.  It is likely the hospital discharge diagnosis versus the hospital admission diagnosis.
Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

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