MDS 3.0; Coding Respiratory Therapy  

Harmony receives a high volume of calls inquiring about the capture of Respiratory Therapy on the MDS 3.0.

According to the RAI User's Manual (page O-14),

For purposes of the MDS, providers should record services for respiratory, psychological, and recreational therapies (Item O0400D, E, and F) when the following criteria are met:

-      the physician orders the therapy;

-      the physician's order includes a statement of frequency, duration, and scope of treatment;

-      the services must be directly and specifically related to an active written treatment plan that is based on an initial evaluation performed by qualified personnel (See Glossary in Appendix A for definitions of respiratory, psychological and recreational therapies);

-      the services are required and provided by qualified personnel (See Glossary in Appendix A for definitions of respiratory, psychological and recreational therapies);

-      the services must be reasonable and necessary for treatment of the resident's condition.

In Appendix A (page Appendix A-18), the following definition is provided as to what is considered respiratory therapy:

Services that are provided by a qualified professional (respiratory therapists, respiratory nurse). Respiratory therapy services are for the assessment, treatment, and monitoring of patients with deficiencies or abnormalities of pulmonary function. Respiratory therapy services include coughing, deep breathing, heated nebulizers, aerosol treatments, assessing breath sounds and mechanical ventilation, etc., which must be provided by a respiratory therapist or trained respiratory nurse. Does not include hand-held medication dispensers.

Because the RAI User's Manual does not specifically define a "Respiratory Nurse," Harmony recommends that the facility staff seek guidance from the State Practice Act in their given state and ensure that nurses are practicing:  

1. According to scope of practice as defined by the Board for Nursing in their individual state and  
2. According to facility policy.

On page O-24 of the RAI User's Manual, the following example is given to reinforce the need to have 15 minutes of more of Respiratory Therapy in a 24 hour period in order to consider (on the MDS) that there has been a "Day" of Respiratory Therapy:

Respiratory therapy services that were provided over the 7-day look-back period:

Respiratory therapy services; Sunday-Thursday for 10 minutes each day.  

Coding: O0400D1 would be coded 50, O0400D2 would be coded 0. Rationale: Total minutes were 50 over the 7-day look-back period (10 × 5 = 50). Although a total of 50 minutes of respiratory therapy services were provided over the 7-day look-back period, there were not any days that respiratory therapy was provided for 15 minutes or more. Therefore, O0400D equals zero days.