The topic of isolation has produced a significant amount of confusion in the long-term care industry.
The reason for the nationwide misunderstanding is because there are different definitions of the term isolation. So, before you engage in a discussion about isolation, pause and be sure to identify the context of the isolation definition subject matter.
In other words, distinguish between one of two situations:
Are you and the facility team discussing
- Isolation in general terms
- Isolation related to coding on the MDS?
Isolation in General Terms
Clinically, the CDC and CMS allows for placing two patients with the same infectious disease in the same room to “isolate” the patient from other patients and contain the threat of spread.
Unfortunately, in the realm of long-term care, this scenario would not allow for the coding of isolation on the MDS.
In other words, cohorting patients is clinically acceptable, but does not constitute the coding of isolation on the MDS.
Isolation MDS Coding
If you have ever experienced this misperception, most likely it is when you understood a patient to be receiving isolation, but then, out of the blue the MDS Coordinator states, “I cannot code that isolation on the MDS,” and your brain cannot comprehend why this is the case.
The reason being is that the MDS has rules of coding, and one cannot code isolation if the patient is cohorted.
The HHI Isolation Documentation and MDS Coding Summary Sheet provides a 2-page synopsis of the requirements necessary to code isolation for each scenario.
- Page 1. Isolation in general terms.
- Page 2. Isolation on MDS.
Prior to referencing the summary sheet, HHI suggests you familiarize yourself with terminology used in infection control situations.
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. “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.”
Using the terms “Quarantine,” “Precautions,” or “Isolation” do not independently support coding isolation on the MDS, nor do they unilaterally define a clinical situation of isolation.
In both situations, Isolation in general terms and Isolation related to coding on the MDS, the facility must meet five requirements:
2. Physician Order
3. Bed Placement
4. Plan of Care