adl coding, section G & significant changes

[MDSinNE]

Our facility is changing the way we code section G of the MDS. We had been having the restorative aide speak to each shift for 7 days and gather information. We are now going to use 7 day ADL coding sheets for the aides to use and code information. We are providing mass inservices for them so they can correctly code.

My problem is that I believe when I start doing the MDS's with these new forms, everyone is going to look like they have had either a significant decline or a significant improvement when in fact they really may not have, it's just because of a change in coding. This also means the quality indicators are going to show the sig. changes too. Obviously we need to look at each resident and determine if they really had a change or it's just because the coding/coder has changed.

Do we need to state this somewhere in the resident's chart so that when the surveyors look at an old mds (previous adl coding) and a new MDS (new & accurate adl coding) and see changes in section G, they know it's been reviewed and determined that it's just because of the new coding/coder.

OR do we do a significant change on everyone? This would be a huge job to have to do.

Any suggestions???

[Talino]

I wouldn't fret much about your concerns.

SCC? No worry. Case and point: ADLs are coded using past 7 days from ARD. If the resident had an acute flare-up of Arthritis during this ARD, the ADL performance will impart a decline. It does not necessarily constitute a Significant Change. When the arthritic flare-up subsides, resumption of usual ADL function is likely.

Suggestion (considering there is really no SCC): When you encounter discrepancies in ADL performances, code Section G9 = '0' No change; Section Q2 = '0' No change.

Keeping a facility record of change in method in MDS coding is a good idea. Justifying non-SCC changes in resident's record is a plus. Considering the time frames used in coding the MDS, the Quality Indicator remains controvertible and still disputed by several facilities in the nation.

What your facility should be more concern about is an audit from DAVE, specially if your miscoded ADLs caused an overpayment.

Good luck with your new ADL coding method!

Try posting in that link I gave you. You might get additional info.

[MDSinNE]

thanks again for your help!!!!

I wouldn't fret much about your concerns.

SCC? No worry. Case and point: ADLs are coded using past 7 days from ARD. If the resident had an acute flare-up of Arthritis during this ARD, the ADL performance will impart a decline. It does not necessarily constitute a Significant Change. When the arthritic flare-up subsides, resumption of usual ADL function is likely.

Suggestion (considering there is really no SCC): When you encounter discrepancies in ADL performances, code Section G9 = '0' No change; Section Q2 = '0' No change.

Keeping a facility record of change in method in MDS coding is a good idea. Justifying non-SCC changes in resident's record is a plus. Considering the time frames used in coding the MDS, the Quality Indicator remains controvertible and still disputed by several facilities in the nation.

What your facility should be more concern about is an audit from DAVE, specially if your miscoded ADLs caused an overpayment.

Good luck with your new ADL coding method!

Try posting in that link I gave you. You might get additional info.

[BHolliRNMS]

Most MDS nurses do tend to under code adl performance. We use an ADL tracking tool, but the med nurses complete it. It took many inservices to get them to understand. Don't know that I would depend on the CNA staff for this documentation.

If some flag out as a sig change from the last assessment, update the careplan with the change and be sure to find out if the change IS an actual decline. Don't assume all declines are from your new system. Be sure to put measures into place as needed through your RNP.

I had this problem just by hiring a new MDS nurse, who looked at things differently from the first one. :)

[Destinystar]

First of all if you are going to implement a new system the best choice would be to do it gradually. Second of all you should implement these new forms only with new admissions, and for residents that already have significant changes, and residents due for annual MDS's that way you wont run into inconsistencies. Finally it is out of the scope of a CNA or an RNA to perform an assessment. Better look at the RN nurse practice act, LPN/LVN nurse practice act, CNA/RNA scope before your facility delegates these tasks to them. In reference to F278 of the State Operations Manual It clearly states (i) Each assessment must be conducted or coordinated with the appropriate participation of health professonals.In Guideline: 483.20 © professionals are further defined as physicians, nurses, rehabilitation therapists, activities professinals, medical social workers, dietians, and other professionals. In probe: 483.20© states "have appropriate health professionals assessed the resident?" Even though the idea your facility came up with is functional in my opinion it does not meet the federal guidelines or the intent of the MDS.

[kdhnursern]

When doing MDSs, you use RAPs to justify whether there was a significant change or not and how you dealt with it. When one MDS Coordinator takes the place of another, they will not see things the same. But that does not affect whether there was a significant change.

The CNAs filling out the 7 day lookback would be nice if they do them. And each of them will not see the same patients exactly like the other CNAs and then you add in the fact that the coding can be difficult to understand.

Also, if I'm not mistaken, wouldn't the form filled out by the CNAs have to become part of the permanent records to justify coding Section G by them? If there are blanks in this record, it's just one more thing surveyors can use against you.