14 day vs DC vs COT.... lost here

crazyforthis · Oct 6, 2011

Also, since this patient missed therapy for medical reasons on 9/30, and the weekend of 10/1 and 10/2, no notes regarding 10/3 from therapy and as I said patinet was dc'd 10/4. Would I date a COT for 10/4 or go back to 10/1 or ?

Does your MDS application have the choice of doing a COT in the reason for Assessments? I know I can do a EOT OMRA but should I since he was dc'd and obviously therapy can't be restarted? Our IT person that manages VistaKeane which is our MDS vendor could not get updates done as he keeps getting error messages etc and has roled the app back to the version we were/are using prior to trying to update. Now we are waiting for a service rep from VK and our IS department to get together and figure out why even the VK rep cannot access the app to do the upgrades... does your MDS app look any different since the Oct 1 changes?

memesha · Oct 6, 2011

Hi. Ok the first thing i understood is that we don't need to do a COT until you have an ard Oct1 or after. This client then does not need a COT yet since 5d ard is 9/29. Yes the client does need an EOT if you want Medicare to pay for the days after end of therapy, EOT ard would then be either 9/30, 10/1, 10/2. Then a discharge with ard 10/4. I hope this is helpfull. And yes our application has the COT option.

Good luck.

andy3k · Oct 10, 2011

I agree with everything that memesha said. In addition, there is no need to combine the 14-day with the discharge since the 14-day is used to set payment for days 15-30 and the resident is discharged before then.

ibtootie · Oct 10, 2011

Okay, Different scenario...Pt admitted on 9/22 for IV antibiotics and surgical wound care post laminectomy and discitis with no need for therapy as Pt is ambulatory and independent with walker. On 10/7 (day 15) Dr. orders P.T. eval and training for gait training with cane. Can the ARD date be set at 10/7 to include both the 14 day and SOT eval?

montecarlo64, ASN, BSN, LPN · Oct 10, 2011

Crazyforthis: I also agree with Memesha and Andy K...

ibtootie: I believe that you will need 2 separate assessments. I count that the 14 day can be set between 10/4 & 10/9 (days 13-18). If therapy evaluated and started minutes on 10/7 (count as day 1), the SOT needs to be set between days 5-7 from the first therapy treatment/evaluation...Otherwise, you will not have enough days or minutes to get a therapy RUG.

crazyforthis · Oct 11, 2011

Another question or clarification please... if Mr X is admitted10/7 and also evaluated for PT and OT sameday (a Friday) but therapy minutes are not started until Tuesday, does that mean he had a 3 day los w/o therapy and require anything special? My PT/OT department asked this in our meeting today. I had thought that as long as therapy was started within 1st 5 days we are okay, but I am not sure where I got that from either. My previous counterpart (now retired) evidently never did EOT's or SOT's for whatever reason... Here we rarely admit, eval AND actually start therapy treatments all in the same day.

xtxrn, ASN, RN · Oct 12, 2011

It's been a while since I did MDSs in TX....the 5 day used to have to projected # minutes for therapy, so the loss for no starting PT/OT isn't as bad....the IVs are going to help as well.

Can you use the grace days to get as many minutes as possible for the 5 day? This would be a good time to use them imo :) The actual # minutes are always going to get the best/ most accurate RUG.

kavdah · Oct 12, 2011

Resident Admit 10/2/11 Picked 5 day to be 10/9/11 (8th day of admit)

14 day pick to be 10/16/11. This will also be first day for rolling assessment

Therapy ended 10/14/11 So need to do an EOT

Can I combine 14 day (10/16/11) with my EOT (2 day after therapy end) and

On 10/16/11 combine with a COT since therapy ended and rug will change?

Thank you for any help, Karen

andy3k · Oct 12, 2011

crazyforthis

Friday was the first day of therapy since that was the therapy evaluation. There was no therapy given on Sat, Sun, Mon so an EOT is due. Since therapy was given on Tuesday, the EOT can be completed, or modified, as an EOT-R.

kavdah

If you complete an EOT before 10/16 then you reset the COT schedule and there is no need for a COT because there is no therapy. If you complete an EOT on 10/16 then a 10/16 COT is not necessary. (ProviderCallFollowUp, page 5)

You cannot combine 14-day, EOT, and COT all together. You would only combine the 14-day and EOT. I do not know enough about Medicare rules to know if you can also submit a separate COT on the same day, assuming that it would classify the resident in a higher RUG because that is the only reason you would want to do one on the same day as EOT.

imkaren2 · Oct 20, 2011

Hi Karen

What RUGs are you getting from those's assessments? You may/may not want to combine them. Your EOT trumps the COT.