QI 10.1 Prevalence of antipsychotic use without conditions

[carrieMDSrn]

Maybe I'm brain dead but I can't seem to understand what causes this QI to flag. We have too many of these flagging in our facility. All of these have what I think is a supporting diagnosis. Can someone explain this QI to me?

[Talino]

In most nursing homes antipsychotics are widely used to manage a behavior problem not related to a psychotic condition. Unless you have any of the ICD9 below to support its use, the flag is unavoidable.

• SCHIZOPHRENIC DISORDERS 295.
  
• PARANOID STATES 297.
  
• NONORGANIC PSYCHOSES 298.

and

• 307.23GILLES DE LA TOURETTE'S DISORDER
  
• 333.4HUNTINGTON'S CHOREA
  

[susanthomas1954]

Check marking the diagnosis in the I section does not "cross over" in the QI. Its a weird thing, but if a patient is on an antipsychotic you HAVE to include the actual code, even if you have check marked the diagnosis. We get this all the time. If you have an antipsychotic, you have to include the diagnosis in I3, or it will flag. That way you have the diagnosis, and you are not using the anti-psychotic without one. It took me about a year to actually call CMS and ask, but they will tell you not to put the diagnosis in unless the treatment has changed for that patient since the last MDS. The problem with that is that it will ALWAYS flag the QI. Your main concern should be that if a trial dose reduction has failed in the past, you document that every quarter, and continue to code the diagnosis as being currently treated. Do your own documentation if you have to. It's too hard to explain. I tried with a person who is new to our building to "help" my department, just today, and I was so fatigued, I came home. She's not stupid, she just doesn't believe me.