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MDS 3.0 Updates 2018

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MDS 3.0 Updates 2018 MDS 3.0 Updates 2018 Cassie Crafton R.N., CDP, RAC-CT Objectives • Understand new MDS 3.0 items in Sections GG, I, J, M, N and O that will be effective October 1st, 2018 • Know which MDS 3.0 items that will be removed and language changes Clarifications with Resident Interviews Timing of Interviews • Section C (BIMS)- to be conducted preferably on the ARD or the day before • Section D (PHQ-9)- to be conducted preferably on the ARD or the day before • Section F (Activities/Preferences)- during the 7 day look back period • Section J (Pain)- to be conducted anytime during the 5 day lookback period preferably on the ARD or the day before Clarifications with Resident Interviews • Staff interview should not be completed in place of resident interview IF the resident interview could have been completed • B0700 should NOT be coded as “Rarely/Never Understood” if any of the resident interviews were completed PPS Changes • Section GG changes • Admission and Discharge Assessments • Language Changes Coding Tips • Admission Performance and Discharge Goals are coded on every Admission Assessment (Start of Part A PPS Stay) regardless of length of stay and planned or unplanned discharge • If the resident has an incomplete stay: – Complete admission performance and goals – Discharge self-care and mobility performance items are not required Section GG- Intent • Functional status is assessed based on the need for assistance when performing self - care and mobility activities • Residents in SNFs have self - care and mobility limitations and are at risk for further functional decline and complications because of limited mobility New Items Section GG • GG 0100 Prior Functioning: Everyday Activities • Intent: To identify resident’s functional status prior to current illness Section GG Prior Functioning • Self Care: Code the resident’s need for assistance with bathing, dressing, using the toilet, or eating prior to the current illness, exacerbation, or injury • Indoor Mobility (Ambulation): Code the resident’s need for assistance with walking from room to room (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury • Stairs: Code the resident’s need for assistance with internal or external stairs (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury • Functional Cognition: Code the resident’s need for assistance with planning regular tasks, such as shopping or remembering to take medication prior to the current illness, exacerbation, or injury Section GG: Prior Functioning • Coding Instructions: – Code 3, Independent- no assistance, with/without assistive devices – Code 2, Needed Some Help- needed partial assistance – Code 1, Dependent- helper completed activity; includes needing 2 person assist – Code 8, Unknown – Code 9, Not Applicable- were not applicable to the resident’s prior to current illness Section GG • New Item Added: G110- Prior Device Used – Check all that apply Section GG • New items GG0130 Self-Care 4 new items Section GG: New items GG0170 • Mobility 7 new items Section GG: GG0170 Mobility Section GG: GG 0170 Mobility Section GG • Coding of GG0130 and GG0170 • 4 “Not attempted” codes items • 10- Not attempted due to environmental limitations ( NEW) Section GG: Coding Instructions • Admission Performance- code based on the first 3 days of Medicare Part A stay • Discharge Performance- code based on last 3 days of Medicare Part A stay • Coding is based on “usual performance” will require clinical judgement • If activity occurs multiple times (e.g., eating, toileting, dressing, bed mobility activities, bed/chair transfers, do not code most dependent, do not code most independent • Some items may only be assessed once, code that status Steps for Assessment Section GG • Activities may be completed with or without assistive device(s). Use of assistive device(s) to complete an activity should not affect coding of the activity. • If the resident’s self-care and mobility performance varies during the assessment period, record the resident’s usual ability to perform each activity. -Do not record the resident’s most independent performance -Do not record the resident’s most dependent performance • Refer to facility, Federal, and State policies and procedures to determine which SNF staff members may complete an assessment. Resident assessments are to be done in compliance with facility, Federal, and State requirements. Discharge Goals Discharge Coding Tips • Use the six-point scale or ‘activity was not attempted” codes to code the resident’s Discharge Goal(s). Use of codes 07, 09, 10, or 88 is permissible to code discharge goal(s). • For the SNF QRP, a minimum of one self-care or mobility goal must be coded. However, facilities may choose to complete more than one self-care or mobility discharge goal. • Use of a dash ( – ) is permissible for any remaining self - care or mobility goals that were not coded. • Using the dash in this allowed instance after the coding of at least one goal does not affect Annual Payment Update (APU) determination. Discharge Coding Tips • Licensed qualified clinicians can establish a resident’s Discharge Goal(s) at the time of admission based on: – Resident’s prior medical condition(s) • Prior and current self care and mobility status • Discussions with resident and family concerning discharge goals – Professional’s standard of practice – Expected treatments – Resident motivation to improve – Anticipated length of stay – Resident’s planned discharge setting/home • Goals should established as part of the resident’s care plan Section GG: Summary 5-Day Assessment Column 1 5-day Assessment Column 2 • All items in column 1 • Must have at least one must be completed discharge goal completed • Base coding on first 3 (may be in GG0130 or days of Med A stay GG0170) • No dashes • May use 1 of the 4 “not attempted” as goals • Choose any number from the 1-6 scale OR • Dash goals not • 1 of the 4 “not completed attempted” codes • Goals may indicate an improvement, maintain, or possible decline Section GG: Summary SNF PPS Discharge Assessment Use of Dashes • All items in Column 3 • Section GG is the must be completed number 1 reason for • Base coding on last 3 2% penalty days of Med A stay • Confusion on coding • No dashes rules • Chose any number • Use of dashes from the 1-6 scale or • Only items used for • 1 of the 4 “not QRP QM calculation attempted codes are subject to the 2% penalty if dashed Section I: New item I0020 • Resident’s primary medical condition • Provides check boxes for 14 different items Section I: New item I0020 • Select the condition that represents the primary condition that resulted in resident’s admission to the nursing facility • If number 14 selected, enter an appropriate ICD-10- CM code in I0020 • If any condition 1-13 selected, then item I0020 is left blank • Includes the primary medical condition in Section I, Active Diagnoses Section I • Code 01, Stroke, if the resident’s primary medical condition category is due to stroke. Example include ischemic stroke, subarachnoid hemorrhage, cerebral vascular accident, and other cerebrovascular disease • Code 02, Non-Traumatic Brain Dysfunction, if the resident’s primary medical condition category is non-traumatic brain dysfunction. Examples include Alzheimer’s disease, dementia with or without behavioral disturbance, malignant neoplasm of brain, and anoxic brain damage • Code 03, Traumatic Brain Dysfunction, if the resident’s primary medical condition category is traumatic brain dysfunction. Examples include traumatic brain injury, severe concussion, and cerebral laceration and contusion Section I • Code 04, Non-Traumatic Spinal Cord Dysfunction, if the resident’s primary medical condition category is non-traumatic spinal cord injury. Examples include spondylosis with myelopathy, transverse myelitis, spinal cord lesion due to spinal stenosis, and spinal cord lesion due to dissection of aorta • Code 05, Traumatic Spinal Cord Dysfunction, if the resident’s primary medical condition category is due to traumatic spinal cord dysfunction. Examples include paraplegia and quadriplegia following trauma • Code 06, Progressive Neurological Conditions, if the resident’s primary medical condition category is a progressive neurological condition. Examples include multiple sclerosis and Parkinson’s disease Section I • Code 07, Other Neurological Conditions, if the resident’s primary medical condition category is other neurological condition. Examples include cerebral palsy, polyneuropathy, and myasthenia gravis • Code 08, Amputation, if the resident’s primary medical condition category is an amputation. An example is acquired absence of limb • Code 09, Hip and Knee Replacement, if the resident’s primary medical condition is due to a hip or knee replacement. An example is total knee replacement. If hip replacement is secondary to hip fracture, code as fracture. Section I • Code 10, Fractures and Other Multiple Trauma, if the resident’s primary medical condition category is fractures and other multiple trauma. Examples include hip fracture, pelvic fracture, and fracture of tibia and fibula • Code 11, Other Orthopedic Conditions, if the resident’s primary medical condition category is other orthopedic condition. An example is unspecified disorders of joint • Code 12, Debility, Cardiorespiratory Conditions, if resident’s primary medical condition category is debility or a cardiorespiratory condition. Examples include COPD, asthma, and other malaise and fatigue Section
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