[sls0703]

The Restorative Nurse and PT are disagreeing on how to do the functional ROM testing for the MDS. THe PT person believes you look soley at the residents function not just their limitations in scoring; ie- they have some ROM in left arm but are still able to comb hair and brush teeth---she would code as a 0/0 because their limitations does not affect their functional ability. My restorative nurse disagrees and states that this wouldn't matter. I just took over doing the 672/802 and have read the instructions. We would have about 1/2 our residents triggering for the contractures because of ROM loss due to pain or other reasons does this sound right?? We only truly have about 6 diagnosed with contractures by an MD so the two are varing greatly. Any suggesstions. I thought having the therapy department taking a peaker woud help but it is making things worse...now my restorative nurse is upset.

Any suggesstions?

[Talino]

The therapist is partially correct.

Coding:

For each body part, code the appropriate response for the resident’s active (or active assisted) range of motion during the past seven days. The process of determining the coding for G4(A) is a 2-step process. First, determine if there is a limitation in active or active assisted ROM. If “no,” code “0.” If “yes,” then go to the next question: Does the limitation in ROM interfere with function or place the resident at risk for injury? If “no,” code “0.” If “yes,” code either “1” or “2.” If the resident is unable to assist with ROM at all, consider that body part as limited. Enter the code in the column labeled (A).

There are a few factors to be considered when resistance is noted during the test for G4A Limitation in ROM - pain, uncooperativeness, or inability to comprehend. The test does not always confirm that there is actual limitation. Observing a resident comb hair/brush teeth proves there isn't. If limitation is actually present on the left arm but resident is able to perform ADLs with the right, then the correct code would be "0"

In G4(B) Loss of Voluntary Mov't, in order to code "0" there must be spontaneous movement of both arms. If the right is OK but the left is deficient, it will be coded as "1"

See RAI, p 3-107 to 3-110