Coding Cognitive Impairment

I've always found that to be one of the most difficult sections to code. We decided as a facility if someone has had their health care proxy invoked, they would be coded a 3 since their ability to make decisions was taken away. I had an MDS nurse once code someone a 1 because she could decide what shoes to wear in the morning. This resident also (and if you're squeamish, stop reading NOW) fished pieces of BM out of the toilet and ate them...a 1???? surely you jest.

lol...since neither candidate is any good...let the demented people vote. Their reasons for their choice probably makes as much sense as anyone elses.

Originally Posted by carol20lpn

Does anyone out there know of a resource for more information on how to code the cognitive impairment "B" on the MDS? The RAI gives some info, but not a whole lot....we have a lot of people that are "ify" between moderate and severe impairment....thanks for any help. carol

Try Appendix F, F-2 Cognitive Performance Scale (CPS) Scoring Rules

Regarding the Decision-Making ability, here's how I would determine capacity...

The "Intent" of B4 refers to everyday decisions about tasks (not only one or two or three ADLs). The coding instruction identifies the resident's skill level.

Therefore, we need to identify ALL the established tasks that the resident is faced with daily. How was his decision-making capacity on each one of them during the past 7 days?

If I were to rephrase the coding definition:

• Decisions were appropriate and consistent on ALL the usual tasks ----> Independent
• Decisions were appropriate and consistent on 1 or 2 tasks but poor on other routines ---> Moderately impaired
• No appropriate decisions were made on any or ALL tasks ---> Severely impaired