mds 3.0: a guide to coding accuracy

MDS 3.0: A Guide to Coding Accuracy

HARMONY UNIVERSITYThe Provider Unit of

Harmony Healthcare International, Inc. (HHI)

Presented by:

Beckie Dow, RN, RAC-MTDirector of MDS/Nursing Education & Training

Speaker Bio

Over 20 Years Experience in Long-term CareClinical and Reimbursement Accuracy in AssessmentsQuality Assurance ActivitiesInterrelation between MDS, Care Planning, QA and Clinical Excellence at the BedsideAANAC Master Trainer

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Program Objectives

Identify three MDS 3.0 Sections vulnerable to errorIdentify strategies for accurate reimbursement through the MDS 3.0 processArticulate three recent MDS 3.0 Coding instruction updates

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Impact of the MDS 3.0

MDS 3.0

Publicly Reported Information

Survey

Resident Care

In Some States,Medicaid

Reimbursement

Medicare Reimbursement



MDS 3.0

Section D:MOOD



A Key Point from the RAI Manual

…the presence of indicators in Section D does not automatically mean that the resident has a diagnosis of depression or other mood disorder Assessors do not make or assign a diagnosis in Section D, they simply record the presence or absence of specific clinical mood indicators


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D0200: Mood Interview (PHQ-9)

Record the resident’s responses as they are stated, regardless of whether the resident or the assessor attributes the symptom to something other than moodFurther evaluation of the clinical relevance of reported symptoms should be explored by the responsible clinician

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D0300: Total Severity Score

PHQ-9 Total Severity Score can be used to track changes in severity over time. Total Severity Score can be interpreted as follows: 1-4: Minimal depression 5-9: Mild depression 10-14: Moderate depression 15-19: Moderately severe

depression 20-27: Severe depression (20-30 for

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Practice/Policy Implications and Potential Staff Education Needs

Provider notification of PHQ-9 changesInvestigation of actual mood issue and root causesPHQ-9 is a single point in time interviewPHQ-9OV should include information from all shifts and disciplinesThe primary CNA should not be the only source of information – let’s talk about why!Follow up plan for D02001 = 1Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved

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MDS 3.0

Section G:FUNCTIONAL STATUS

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Activities of Daily Living (ADLs)Key Points Regarding MDS CodingThe intent is to capture what the

resident actually does, not what they could, would or should doAssistance needed varies from day to day, from shift to shift and even during a particular shiftThe reason that the assistance was required is irrelevant; it simply matters that it was needed



Self Performance = 0 (Independent)

No help or staff oversight at any time (and ADL occurred at least three times)


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Self Performance = 1(Supervision)

Oversight, encouragement, or cueing was provided three or more times





Self Performance = 2 (Limited Assistance)

Resident was highly involved in activity and received physical help in guided maneuvering of limb(s) or other non-weight-bearing assistance three or more times




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Self Performance = 3 (Extensive Assistance)

Weight-bearing support provided Full staff performance of activity during part but not all of the activityThree or more instances of weight bearing assistance




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Self Performance = 4 (Total Dependence)

Full staff performance of an activity with no participation by resident for any aspect of the ADL activity occurred three or more timesThe resident must be unwilling or unable to perform any part of the activity



Activities of Daily Living (ADL)

ADL Support Provided: Code for most support provided over all shifts; code regardless of resident’s self-performance classification

Coding:0. No setup or physical help from staff1. Setup help only2. One person physical assist3. Two+ persons physical assist8. ADL activity itself did not occur during entire period



The Four Late Loss Activities of Daily Living (ADLs)

Bed MobilityTransferEatingToilet Use



Practice/Policy Implications and Potential Staff Education Needs

Documentation to support coding is a mustFocus on four late loss ADLsAccuracy begins at the bedside with the CNA all three shifts (don’t forget nights!)Ensure reporting and/or documentation all other disciplines regarding ADLsEducate frontline nursing staff as well as IDTEnsure an audit protocol (MDS and documentation)Copyright © 2013 All Rights Reserved


MDS 3.0

Section M:SKIN CONDITIONS


Section M: Skin Conditions

Asks the clinician to determine if at risk for pressure ulcersIncludes updated pressure ulcer definitions Must determine present on admissionIncludes diabetic foot woundsNo longer back stage pressure ulcersOnly stage pressure ulcers



M0300: Current Number of Unhealed Pressure Ulcers at Each Stage

Stage 1 – 4Unstageable – non-removable dressingsUnstageable – Slough and/or escharUnstageable – Deep tissue Injury

Note: No RUG impact from Stage 1 or unstageable due to non-removable dressing or DTI



M0610: Dimensions of Largest Unhealed Stage 3, 4 or Slough/Eschar Pressure Ulcer

Length, Width, Depth

M1040: Other Ulcers, Wounds and Skin Problems M1200: Skin and Ulcer Treatments – for treatment and/or prevention


Section M – Key Points

Present on admissionMeasuring practicesStaging competencyDetermination and documentation of wound etiology (scope of practice and QOC issues)Risk assessments leading to interventions reflected in the plan of care

MAY 2013 RAI USER’S MANUAL

UPDATES



Medicare Advantage to Medicare A

If a resident goes from Medicare Advantage to Medicare Part A, the Medicare PPS schedule must start over with a 5 -day PPS Assessment as the resident is now beginning a Medicare Part A stay


Patient Gender

A dash (-) is no longer an acceptable response for Gender in item A0800The gender of the patient must match the gender that is in the Social Security SystemIf the gender on the MDS assessment does not match the gender in the Social Security system, a fatal error will occur and the MDS assessment will be rejected from the QIES ASAP systemIf a dash (-) was used on a previous assessment, that dash must be replicated in Section X, correction request


Section G

Changes to Section G were minimalCMS is assessing whether more substantial changes should be made at a later dateCMS strongly advises that staff who are coding section G become very familiar with RAI Users Manual, Pages G-1 through G-17


Section G

“When there are three or more episodes of a combination of full staff performance, weight-bearing assistance, and/or non-weight-bearing assistance—code limited assistance (2)” The ADL algorithm was also updated to reflect the change of “and” to “and/or” and the full definition of extensive assist to match the manual text


Section L

Mouth or facial pain captured in L0200F should also be coded in Section J, items J0100-J0850, in any items in which the coding requirements of Section J are met


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Section L

In May 2013, CMS posted a new video to assist assessors in oral examinationsThe video may be found at:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TrainingMaterials.html

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Section M

Multiple clarifications were made to Section MConsistent with current practice and coding instructionsMany new examples for coding skin problems were added


Chapter 5 (Submission Requirements)

Chapter 5 was updated with the May 19th changes to the submission policyProviders are now able to modify Entry and Discharge dates, Assessment Reference Date, and Reason for Assessment under limited circumstances


Chapter 5 (Submission Requirements)

During the June 2013 Open Door Forum call, CMS addressed a typo found on page 5-2This typo incorrectly states the completion guidelines for and admission assessmentProviders are instructed to follow directions for assessment timing that are found in Chapter 2


Questions/Answers

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