Question on the ambulation part of mds

[litbitblack, ASN, RN]

Hey all First of let me say I am not an MDS nurse. I am a bit confused on what our facility mds nurse is telling us to chart on our monthly summaries. This concerns the ambulation part of the mds. We have patients that propel themselves with thier feet in a wc. This person does not walk at all and barely stands for transfers. We were told that on the monthly summaries we need to code they are ambulating with limited assistance and we are to mark it that way. Basically mark it that way if they are in a wc. Now to me I think it should be that the activity didn't happen and then address it in locomotion but I can't find any examples for this particular type of situation. I need the info to back up if I am going to say anything to her about it as she has specifically came back and said it needs to be coded that way. Thanks for any info.

[Talino]

Most dictionary defines "walk" "to proceed through, over, or upon at a moderate pace on foot; move by advancing the feet alternately so that there is always one foot on the ground in bipedal locomotion, etc." There is no specific reference that walking is achieved solely while "standing" on foot. Even with the definitions referring solely to the feet, who would dispute this as not walking ->

Arguably, this is really not an issue of whether the resident is actually walking or not. When a resident normally propels the wheelchair w/ his feet, when does it constitute a program? Does it meet the guidelines of a program? If you do capture it as ambulation program, make sure Walk in room or corridor is not both coded as 8/8?

Although CMS does not specify that the walking activity solely meant advancing the feet alternately while "standing", I doubt if the surveyor would see the logic of walking while seated. The burden of proof is yours.

[litbitblack, ASN, RN]

Ok so I can see where if they propel themselves with thier feet how it can be considered somewhat of a walk but she (mds nurse) has said that if they are in a wc we mark ambulation also. How is that one possible?

[SRK77]

I may be wrong, but if they can move around in their wheelchair, then I thought that would be addressed in the locomotion sections. I mostly see 0/0 and 4/2.