Harmony Healthcare International (HHI) Blog

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

C.A.R.E.

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


Update on Red Keyboard Button Enter on Black Computer Keyboard.Question and Answer with Sally Fecto, Sr. VP Field Operations Harmony Healthcare International (HHI) 

The MDS Updates Free Key Friday Webinar on August 31, 2018 spurred an overwhelming amount of MDS questions.  As promised, the answers are available today and over the next 3 blogs in a 4-part series. We appreciate all your inquiries and positive feedback. We hope to see you at harmony18 (the 7th annual LTPAC Symposium)!  We look forward to having a “Party in our Brains” with Kris Mastrangelo and have an all-star lineup of speakers, guests and some very special surprise meet and greets! 

In addition, Kris will be presenting tomorrow’s Free Key Friday Webinar September 21, 2018 on:  “It’s the Census, Genius!”  This will be at 1:00 EST. Click Here to Register. 

  1. How are we supposed to gather information for Prior functioning? Would it be from interview with resident/family?

    Yes, ask the resident or his/ her family and review the resident’s medical records to obtain the resident’s prior functioning with everyday activities. 
  1. Would dependence on a chair that elevates sit to stand be coded as a full body lift?

    The mechanical lift, includes sit-to-stand, stand assist, and full-body-style lifts.  This activity and use of lift focuses on the transfer.  The assessment of sit to stand is the usual performance over the observation period.  It is recommend observing how the resident moves from other seated positions, such as a wheelchair.  If the only transfers- sit to stand, are primarily as described, the RAI instruction details to code 01, Dependent: if the helper does ALL the effort. It is important to determine if the resident does none of the effort to complete the activity, or the assistance of two or more helpers are required for the resident to complete the activity.
  1. Prior device- if the patient is using the wheelchair as her walker when ambulation can we consider that under walker too?

    Prior device, use of a walker, refers to all types of walkers such as pickup walkers, hemi-walkers, rolling walkers, and platform walkers.  The RAI User’s Manual does not identify pushing a wheelchair as an example for coding use of walker. 
  1. How do you determine usual for example 1 instance limited 1 instance independent and 1 instance extensive how would you determine the usual?

    The usual performance is based over the observation period and includes episodes of the resident performing the functional task. The RAI instructions do not provide a specific algorithm to make this determination and acknowledges that a resident’s functional status varies.

    Focus on the resident’s usual ability to perform each activity. Do not record the resident’s best performance and do not record the resident’s worst performance, but rather record the resident’s usual performance. Instructions state for the clinician to make the determination after considering the entire observation period. 

  1. For the 3-day assessment period on the D/C section GG....does that include the discharge date or is it the last three covered days?

    Section GG at discharge includes the ARD of the physical discharge or last covered day with a level of care change. The Part A PPS Discharge assessment is completed based on the resident’s Medicare Part A Stay ends as documented in A2400C, End of Most Recent Medicare Stay.

    Collect data for the 3rd, 2nd and last day of the stay, or discharge date for planned discharges. 
  1. Would donning/doffing TED hose fall under LB dressing or footwear?

    TED hose (anti-embolism stockings) are considered under Lower Body dressing and assessed as a piece of clothing.  Per the RAI User’s Manual:  If donning and doffing an elastic bandage, elastic stockings, or an orthosis or prosthesis occurs while the resident is dressing/undressing, then count the elastic bandage/elastic stocking/orthotic/ prosthesis as a piece of clothing when determining the amount of assistance the resident needs when coding the dressing item. 
  1. How does this correlate with Section G for example if Section GG is coded for eating as limited with a goal of supervision but Section G is coded as independent every time for the 3-day look back?

    Section G and GG have different coding time frames and coding instructions.  GG is looking at the usual over the possible 3-day observation period, while Section G is looking at a possible 7-day observation period with a coding algorithm that defines the residents Self-Performance and the most staff assistance provided.  If GG has limited assistance coded and it is within the observation period that occurred within the 7-day coding period for Section G, one would expect Section G to be at least a Supervision level and not Independent.  Section G coding of Independent indicates that the resident was Independent with all eating activities during the entire lookback period.  The coding of Section G must include all care encounters and if anything, other than Independent occurred, the coding of Independent will not be accurate if any other level of self-performance or support provide, even one time.
  1. If resident admitted and 5d completed prior to 10/1, how would DRR questions be answered upon discharge if after 10/1?

    The Drug Regimen Review is conducted not only upon the resident’s admission or start of a SNF PPS Stay, but also asks if interventions were completed throughout the resident’s stay through the Part A PPS discharge.  The discharge assessment asks only:  if the facility contacted and completed the physician prescribed or recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission.  
  1. With the current changes in Section I, is using Alzheimer's Dementia and/or Dementia as primary Dx in the UB-04 Dx List able to strongly support skilled rehab services?

    The supportive diagnosis for skilled therapy is likely not the Alzheimer’s Dementia, as a primary condition.  The primary diagnosis is the diagnosis chiefly responsible for the admission to, or continued residence in, the nursing facility and sequenced first.  List diagnosis codes that support services provided during claim dates of service.  Answer the question:  Why does the resident need skilled rehab services?
  2. What category would psych diagnosis be? substance/ETOH abuse?

    These diagnoses are not specifically identified or included in Codes 1-13.  Use Code 14, for Other Medical Condition, if the resident’s primary medical condition category is not one of the listed 13 categories. Enter the ICD-10 code in I0200A.
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. 

harmony20 October 29-30 2020 Encore Boston Harbor

Topics: MDS 3.0

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