MDS 3.0: A Guide to Coding Accuracy

MDS 3.0:
A Guide to Coding Accuracy
HARMONY UNIVERSITY
The Provider Unit of
Harmony Healthcare International, Inc. (HHI)
Presented by:
Beckie Dow, RN, RAC-MT
Director of MDS/Nursing Education & Training

Speaker Bio
Over 20 Years Experience in Long-term
Care
Clinical and Reimbursement Accuracy in
Assessments
Quality Assurance Activities
Interrelation between MDS, Care
Planning, QA and Clinical Excellence at
the Bedside
AANAC Master Trainer
Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 2

Harmony Healthcare International, Inc. 3
Program Objectives
Identify three MDS 3.0 Sections
vulnerable to error
Identify strategies for accurate
reimbursement through the MDS 3.0
process
Articulate three recent MDS 3.0 Coding
instruction updates
Copyright © 2013 All Rights Reserved

Impact of the 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

7
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
mood
Further evaluation of the clinical
relevance of reported symptoms should
be explored by the responsible clinician
Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved

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 PHQ-
9OV)
Harmony Healthcare International, Inc. 8Copyright © 2013 All Rights Reserved

9
Practice/Policy Implications and
Potential Staff Education Needs
Provider notification of PHQ-9 changes
Investigation of actual mood issue and root
causes
PHQ-9 is a single point in time interview
PHQ-9OV should include information from
all shifts and disciplines
The primary CNA should not be the only
source of information – let’s talk about why!
Follow up plan for D02001 = 1

10
MDS 3.0
Section G:
FUNCTIONAL STATUS

11Harmony Healthcare International, Inc.
Activities of Daily Living (ADLs)
Key Points Regarding MDS Coding
The intent is to capture what the resident
actually does, not what they could, would
or should do
Assistance needed varies from day to day,
from shift to shift and even during a
particular shift
The 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)

Self Performance = 1
(Supervision)
Oversight, encouragement, or cueing
was provided three or more times

(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

(Extensive Assistance)
Weight-bearing support provided
Full staff performance of activity during part but not
all of the activity
Three or more instances of weight bearing assistance

(Total Dependence)
Full staff performance of an activity
with no participation by resident for
any aspect of the ADL activity occurred
three or more times
The 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 staff
1. Setup help only
2. One person physical assist
3. Two+ persons physical assist
8. ADL activity itself did not occur during entire
period

The Four Late Loss Activities of
Daily Living (ADLs)
Bed Mobility
Transfer
Eating
Toilet Use

Practice/Policy Implications and
Potential Staff Education Needs
Documentation to support coding is a must
Focus on four late loss ADLs
Accuracy begins at the bedside with the CNA all
three shifts (don’t forget nights!)
Ensure reporting and/or documentation all other
disciplines regarding ADLs
Educate frontline nursing staff as well as IDT
Ensure an audit protocol (MDS and
documentation)

MDS 3.0
Section M:
SKIN CONDITIONS

Section M: Skin Conditions
Asks the clinician to determine if at risk
for pressure ulcers
Includes updated pressure ulcer
definitions
Must determine present on admission
Includes diabetic foot wounds
No longer back stage pressure ulcers
Only stage pressure ulcers

M0300: Current Number of Unhealed
Pressure Ulcers at Each Stage
Stage 1 – 4
Unstageable – non-removable dressings
Unstageable – Slough and/or eschar
Unstageable – 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 admission
Measuring practices
Staging competency
Determination 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 A0800
The gender of the patient must match the gender that
is in the Social Security System
If 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 system
If 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 minimal
CMS is assessing whether more
substantial changes should be made at a
later date
CMS 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

Section L
In May 2013, CMS posted a new video
to assist assessors in oral examinations
The video may be found at:
http://www.cms.gov/Medicare/Quality-
Initiatives-Patient-Assessment-
Instruments/NursingHomeQualityInits/
NHQIMDS30TrainingMaterials.html

Section M
Multiple clarifications were made to
Section M
Consistent with current practice and
coding instructions
Many new examples for coding skin
problems were added

Chapter 5 (Submission Requirements)
Chapter 5 was updated with the May
19th changes to the submission policy
Providers 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 5-2
This typo incorrectly states the
completion guidelines for and
admission assessment
Providers are instructed to follow
directions for assessment timing that
are found in Chapter 2

Questions/Answers
Harmony Healthcare Internationa
1 (800) 530 – 4413
Bdow@harmony-healthcare.com
www.harmony-healthcare.com

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MDS 3.0: Accurate Coding for
Accurate Reimbursement
August 21, 2013
12:00-1:00 (ET)

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MDS 3.0: A Guide to Coding Accuracy

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