From the desk of our CEO Kris Mastrangelo:
MDS 3.0 Section G: Eating
Power Tips to Coding
Harmony has been questioned many times since the inception of MDS 3.0 on the detailed changes with RUG-IV for ADL scoring. Under RUG-IV there are additional ADL splits for the nursing categories which heighten the potential to increase a RUG level with the capture of ADL assist provided. There are significant financial increases under RUG-IV with accurate reporting and capture of ADL assistance provided.
Under RUG-IV, there is the opportunity to receive 4 of the total 16 ADL points for eating when assist is provided to the resident for eating. This equates to 25% of the total ADL score.
The following table reflects the ADL points assigned for eating under RUG
-IV:
|
Self-Performance
(Column 1)
|
Support
(Column 2)
|
ADL Score
| |
-, 0, 1, 2, 7, or 8
|
-, 0, 1, or 8
|
0
| |
-, 0, 1, 2, 7, or 8
|
2 or 3
|
2
| |
3 or 4
|
-, 0, or 1
|
2
| |
3
|
2 or 3
|
3
| |
4
|
2 or 3
|
4
|
Per the MDS 3.0 RAI Manual coding criteria for eating assist, a patient must be independent the entire 7 day look back in order to code ADLs as independent. If a patient received 1 episode of assist, MDS coding guidelines instruct coding Supervision (1). The ADL support code would be the most support provided (even if 1 episode), assist of 1 (2). Therefore, if a patient receives 1 episode of limited or extensive assist, the correct coding is 1,2.
Even high functioning patients may receive additional levels of assist close to the time of admission and require decreased assistance as they progress. It is not uncommon for a patient to require eating assist on the day of admission. Documenting this assist provided for eating 1 time in the ARD period may result in a RUG increase.
There are various areas within the medical record that provide information that must be considered when coding Section G of the MDS. The nurse's notes are one source for completing Section G. Harmony reinforces the value of auditing all aspects of the medical record (i.e., therapy notes, CNA flow sheets, nursing notes). In addition, MDS coordinators may consider incorporating an interview into the assessment process. Interview is essential to accurately code the MDS. This can be very supportive in the presence of under coded flow sheets
Harmony recommends each facility institute a heightened focus on eating assist provided by facility staff.
NEW Program: Jen Pettis, RN, WCC, RAC-MT, Program Development Manager and Regional Consultant for Harmony Healthcare is pleased to present the Quality Indicator Survey Preparedness Program. This is an educational program designed for all levels of facility leadership. We are currently seeking facilities to host this program. Contact us at 800-530-4413 x21 and ask for Sue Pellegrini.
Winter Webinars
January 27, 2011
MDS 3.0 for the Therapy Professional
February 3, 2011
MDS 3.0 FAQs
February 10, 2011 Pain Assessment and Coding February 17, 2011 [1/2 Day Seminar] 9:00AM - 12:00PM, Topsfield, MA Medicare Nursing/Therapy Documentation in a SNF and MDS 3.0 Documentation for the CNA
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