Discharge before 5-day assessment

Specialties MDS

Published

I recently had a patient that was admitted to my facility and discharged back to the hospital with return not anticpated. The patient received two days of therapy while there. I am an short-term skilled nursing facility. How would I code the MDS. Since he was there less than 5 days do I need to do the MDS or do I do an entry tracking record, code the MDS 99, and do a discharge?

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Specializes in long term care - MDS.

I just went thru this twice in the past week. Depending on your software, I would do an entry first or reentry. Then I had to do a five day, start of therapy, discharge (combined) using the discharge date as the ARD. Our software didn't have a short stay option, but by putting in start of therapy and the discharge date it came up later in the assessment that wasn't accessable.

I thought I could just do a five day using the day of discharge as the ARD. And I could have, but it would not have captured a rehab RUG score. Since with 3.0 they eliminated section T, it is the only way to get an estimate. I just thought they did away with it. It was my rehab mgr who taught me.;)

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What if the resident is admitted skilled for therapies on say , a Friday night after I leave ...no one from therapy even has seen them as eval is planned for Monday... and resident is dich back to hospital on Sunday before I ever see them either?

This happened this month, so from the chart I did an entry tracking, ARD Fridays date, and a d/c return anticipated with the ARD of Sunday (she has since never returned)

Now our corporate office is bugging me for an admission and 5d adm so they can get a RUG... I told them no therapy was ever in yet, and no nursing area to skill on my knowledge, and she wasnt here but 48 hours so I ddint need to do a 5 day or admission ...

then I started to wonder.... should I have done a d/c combined with a 5 day on day 2 even though therapy never saw her ?????

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Specializes in ER CCU MICU SICU LTC/SNF.
should I have done a d/c combined with a 5 day on day 2 even though therapy never saw her

Yes. Regardless therapy hasn't commenced nor were there any skilled nursing service provided, you should prepare a Medicare-required assessment (5-day) as completely as possible and submit the assessment as required. If there is no PPS MDS in the QIES ASAP system, the provider can only bill the default rate (equivalent to RUG Score - PA1) for any Medicare days.

However, you still can make a correction, revise the assm't codes, and obtain a more desirable RUG score.

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I just had a patient return from the hospital and did an entry and then she went back out 2 days later. My software would not let me do a short stay and discharge but I was able to combine a 5 day and discharge. What I can't understand is if your allowed to use dashes ie: on a discharge, than why do you have to do all those pages?? Dashes aren't giving anyone any information especially when you have not had the chance to assess the patient!!!

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CMS wants as much information as they can get for research. I can picture CMS saying, "If you get tired of putting dashes, feel free to collect real data." ;)

Having been on the data collection and research side of things, I can tell you that some data is better than no data.

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