Fall/New Admission/SCSA

[Liza22]

If you have a new admit who sustained a fall with a fracture on the 2nd week of the admission date, and admission/5day assessment still in process. Would you open a significant change assessment?

Usually I would compare with previous assessment to see if I have 2 or more areas of decline, however in this case not only I don't have a previous assessment to compare and also the fall would not be captured on the only assessment I have since it happened outside of the look back period.

[Talino]

Do the 5D separately. You have up to 14 days to complete the Adm so maybe you’ll be able to capture the status after the fracture if you move the ARD. If not, just proceed with the Adm/5D as scheduled. Observe and document within 14 days if the sig. change criteria is met. Complete the SCSA within 14 days after.

[Talino]

As an afterthought, was the resident discharged to hospital for the fracture?

[Liza22]

23 hours ago, Talino said:

As an afterthought, was the resident discharged to hospital for the fracture?

No, I don't think so.

Talino, I have a question regarding Primary diagnosis/PDPM. If you have patient admitted from SNF after recent hospitalization for sepsis/uti/aspiration pneumonia and completed antibiotics at the hospital. Would you code for pneumonia as primary diagnosis ?

[Talino]

Even these conditions are resolved in the hospital, they are likely the reason for debility requiring skilled care in your facility. Hence, any of these is an acceptable primary dx.

[Liza22]

Thank you.

[TigerxLiLy]

On 3/29/2020 at 6:33 PM, Talino said:

Even these conditions are resolved in the hospital, they are likely the reason for debility requiring skilled care in your facility. Hence, any of these is an acceptable primary dx.

Read on a AANAC article that if the D/C summary states that the dx is resolved, we cannot use the diagnosis, even if the main reason needing therapy services - that a MD Query must be completed to support that dx is in fact “active”... — article quoted here:https://www.aanac.org/Today-in-Long-Term-Care/post/mds-item-i8000-solve-common-coding-problems-under-pdpm/2020-04-01

“Resolved diagnoses. The coding instructions on page I-7 in chapter 3 of the RAI User’s Manual state, “Do not include conditions that have been resolved, do not affect the resident’s current status, or do not drive the resident’s plan of care during the seven-day look-back period, as these would be considered inactive diagnoses.”

Coding resolved diagnoses is an issue at some facilities, says Maher. “For example, the hospital discharge summary may include a resolved diagnosis of pneumonia, but the IDT believes it’s still an active diagnosis because the SNF is providing antibiotics or doing lung assessments and therapy related to the pneumonia, so the NAC codes it in section I.”

If the hospital discharge summary states that a diagnosis is resolved, the IDT can’t decide that it is still affecting the resident and needs treatment—and can be coded on the MDS, says Maher. “When the IDT believes that a diagnosis is active even though a physician says it is resolved, the appropriate step is to query the resident’s attending physician, I.e., ask whether the attending physician would document that the diagnosis is still an active diagnosis related to the continuing need for treatment for that diagnosis. Taking this step is important for payment in PDPM—and also to ensure that the diagnoses accurately reflect the resident’s diseases and conditions.”

I used to have MD query forms at my old facility (we placed them in the Physical chart to have back up documentation) but my new one does not (they have us calling the Dr, asking about the dx, and asking if they can addendum the progress note they did in the ARD window- which it sometimes doesn’t happen/no back up documentation) ... anyone happen to have a MD Query form?

[TigerxLiLy]

Kinda sounds like redundancy/annoying the providers with stuff that’s obvious...

[Talino]

5 minutes ago, TigerxLiLy said:

“Resolved diagnoses. The coding instructions on page I-7 in chapter 3 of the RAI User’s Manual state, “Do not include conditions that have been resolved, do not affect the resident’s current status, or do not drive the resident’s plan of care during the seven-day look-back period, as these would be considered inactive diagnoses.”

In the conditions mentioned above, we are not providing skilled services for a diagnosis that is resolved but for the consequential effects of the treated condition/s. In most cases, patients experienced debility during the period of illness and recuperation while in hospital. Short term Rehab is usually recommended on discharge. SNF do not provide Rehab treaments for UTI or Pneumonia, but skilled therapies to regain physical strength. Unfortunately, therapy treatment diagnosis are not valid as primary. And there is no valid aftercare codes as in fractures. Hence, the SNF must choose the root cause for "deconditioning" which takes you back to the reason the resident was treated for in the hospital - that be UTI, PNA, or Sepsis.

An example is a therapist's assm't and evaluation. Very seldomly will they identify "muscle weakness" or "need for assistance with personal care" without also mentioning the causative illness.

Another example is your Physician Certification - "I certify that SNF services are required to be given on an inpatient basis because of the above named patient's need for skilled nursing care on a daily basis for the condition(s) for which he/she was receiving inpatient hospital services prior to his/her transfer to the SNF".

But when in doubt, verify with you Medicare Administrative Contractor (MAC).

[TigerxLiLy]

Sigh. Completely makes sense - especially with the certification listing the diagnosis/md signing it :).

thank you