Harmony Healthcare Blog

The MDS Coding Corner: Isolation Criteria

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Feb 14, 2017
Kris Mastrangelo, OTR/L, LNHA, MBA
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Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Infectious Disease.jpgHarmony Healthcare International (HHI) chart audits across the country reveal a trend in MDS Coding of isolation.  Further scrutiny shows that these coding instances are sometimes lacking documentation to accurately support the coding, while at other times, the coding is a product of definition confusion. For clarification purposes, this blog discusses the coding of isolation or quarantine for active infectious disease (MDS item O0100M). 

The Centers for Medicare and Medicaid Services (CMS) clarified the requirement to code O0100M, isolation or quarantine for active infectious disease, on the Minimum Data Set, version 3.0 (MDS 3.0) only when all of the following conditions are met: 

  1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.
  2. Precautions are transmission-based precautions (contact, droplet, and/or airborne).
  3. The resident is in a room alone because of active infection and cannot have a roommate.
  4. The resident must remain in his/her room and all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.). 

Harmony Healthcare International (HHI) reminds providers, that regardless of the above criteria, the isolation criterion does not apply for:   

  • urinary tract infections,
  • encapsulated pneumonia, and
  • wound infections per RAI criteria.
Free RUG Analysis - Compare your facility's utilization with current national CMS data

Harmony Healthcare International (HHI) recommends the following steps when a patient does meet the definition of isolation: 

  • Update the Facility policy for Isolation.
  • Physician Documentation to support the case and rationale for isolation.
  • Physician’s Order depicting isolation
  • Track isolation on a TAR/MAR to identify the exact days in which isolation occurs.
  • Be sure the Care plan addresses interventions to reduce the negative impact of isolation.
  • Review the patient status for Significant Change MDS.

P.S. One more nugget: Non-comprehensive MDS Assessments - Section O (Procedures) do not include the option of coding “none of the above” and may contributing to inadvertently coding Isolation when the criteria are in fact not met.

If you need assistance with the MDS Coding of Isolation, please contact us by clicking here or calling our office at (800) 530-4413. 

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Topics: Isolation, Infectious Disease

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