The CDC states the Delta Variant of SARS COVID-19 is more than 2 times as contagious as previous variants. The Delta Variant is more transmissible than its predecessors because it has mutations in the spike protein that makes it much more effective in attaching and entering human cells.
In July of 2021, many major news outlets (The Washington Post, New York Times, CNBC, Reuters, Newsweek, and Al Jazeera) reported that a leaked CDC memo indicates that the Delta Variant of SARS COVID-19 is more transmissible than MERS, SARS, Ebola, a common cold, seasonal flu, and smallpox and is as contagious as chicken pox.
The “viral load” is the amount of virus that is detected in the lab tests. Generally speaking, viral load is correlated with severity of symptoms. A high viral load translates to sicker and higher risk of death. A low viral load translates to less sick and lower risk of death.
As early as December of 2020, Daniel Griffin, MD, PhD, clinical instructor of medicine, and Stephen Goff, PhD, the Higgins Professor of Microbiology and Immunology and Biochemistry and Molecular Biophysics at Columbia University were reporting that COVID 19 patients with mild symptoms saw a significant drop in viral load within the first week of infection, while patients whose viral loads remained high after a week of infection were “significantly more likely to be hospitalized or die.”
Recent publications have data that shows that the initial viral loads of vaccinated and unvaccinated persons rise at “identical rates” for the first few days. Around day 5, the viral load in vaccinated persons begin to drop quickly.
This information helps people understand how vaccinated persons can still spread the virus without getting seriously ill themselves. During the first five days of infection, their viral load is high, but it drops quickly, so they don’t get seriously ill.
For most in the industry, the Delta surge has rekindled memories of previous outbreaks.
Are you Skilling the Medicare Part A Beneficiary Correctly?
With this surge of COVID-19 Delta Variant in the nursing homes across the country, HHI wants to remind providers about the aspects of Medicare Part A Skilled Coverage Criterion.
Skilled (Medicare Part A) Observation and Assessment is Indicated when there is a reasonable probability or possibility for complications or the potential for further acute episodes. This references conditions where there is a “reasonable probability or possibility” for:
- Potential for further acute episodes
- Need to identify and evaluate the need for modification of treatment
- Evaluation of initiation of additional medical procedures
Daily observations and assessments include but are not limited to, fever, dehydration, septicemia, pneumonia, nutritional risk, weight loss, blood sugar control, impaired cognition, mood, and behavior conditions.
- Example of Daily Skilled Documentation
- “This patient requires daily skilled nursing observation and assessment of signs and symptoms related to exacerbation of COVID-19, pneumonia, and related medical conditions.”
Skilled observation is required until the treatment regimen is essentially stabilized, and the patient is no longer at risk for medical complications.
Are you Skilling the Isolated and Quarantined patient correctly?
Both the quarantined and isolated resident may qualify for skilled coverage.
The Isolated Beneficiary
According to the CDC, isolation is for people who are ill, while quarantine applies to people who have been in the presence of a disease but have not necessarily become sick themselves. Per the CDC,
“Isolation separates sick people with a contagious disease from people who are not sick.”
Isolation is for patients with symptoms and or positive tests. Quarantine is for patients exposed but exhibits no symptoms. Coding isolation for a patient with an active infectious disease places them into an ES1 nursing category under both Medicare Part A and certain Medicaid Case Mix states.
Isolation (Z29.0) and COVID-19 (UO7.1)
To properly code isolation on the MDS, the patient requires:
- Isolation for a minimum of one day
- MD Orders for isolation
- Active Infectious disease ICD-10 coded:
- On the UB-04 and
- On the MDS (Section O. and I.)
- All treatments rendered in the patient’s room with documentation to support said services are provided at bedside
- Isolation cannot be coded if the patient is being “co-horted”, meaning rooming with another patient
The Quarantined Beneficiary
Although a quarantined patient may not have symptoms, the mere fact the patient was potentially exposed to COVID-19 warrants daily skilled nursing to observe and assess for signs and symptoms of COVID-19.
Observation and Assessment references conditions where there is a “reasonable probability or possibility” for the nurse to:
- Evaluate the patient’s condition i.e., observe and assess for fever, body aches, loss of appetite,
- Identify acute episodes, and
- Identify the need for treatment (modifications)
- Initiate treatment changes
In addition, the nurse may provide observation and assessment of signs and symptoms related to:
- Nutritional risk,
- Weight loss,
- Blood sugar control,
- Impaired cognition and
- Mood and behavior conditions
Nurses need to document the defined assessment on a daily basis. This may include neurological, respiratory, cardiac, circulatory, pain/sensation, nutritional, gastrointestinal, genitourinary, musculoskeletal, and skin assessments. In these situations, the Nurse may write:
“This patient requires daily skilled nursing observation and assessment of signs and symptoms related to COVID-19.”
Skilled observation is required until the treatment regimen is essentially stabilized.
HHI is here to help providers. HHI consults, educates, and trains the healthcare industry on Compliance, Analysis, Audit, Regulatory, Rehabilitation, Reimbursement, Education, Efficiency and Survey.
Harmony Healthcare International (HHI) is hosting our 9th Annual Post-Acute and Long Term Care (PALTC) Interdisciplinary Symposium on Thursday, October 21st, 2021, and Friday, October 22nd, 2021 at the Encore Boston Harbor resort and casino.
Click below to register and for more information!
Harmony Healthcare International (HHI) was founded in 2001. Harmony Healthcare International (HHI) is a recognized healthcare consulting firm that uses a systematic approach in addressing the C.A.R.E.S. platform, which encompasses: Compliance, Analysis, Audit, Regulatory, Rehabilitation, Reimbursement, Education, Efficiency and Survey.
"HHI’s on-site and off-site medical record review process is the nucleus for C.A.R.E.S. optimization and ongoing systems improvement."
Kris Mastrangelo OTR/L, LNA, MBA
President and CEO
Harmony Healthcare International, (HHI)
HHI consults, educates, and trains on:
- Audit and Monitoring,
- Facility Assessment,
- Five-Star Quality Rating,
- Infection Control,
- Program Development,
- Quality Measures,
- Reimbursement (PDPM, Case Mix, Medicare, Medicaid, HMOs),
- Revenue Cycle Management,
- Staff Recruitment,
- Staff Retention,
- Survey (Process, IIDR, IIDR, Appeals),
- Team Building and
- Value Based Purchasing to just name a few.