help!!! pps assessment

silverbat · May 22, 2014

I'm not Talino, :sarcastic: , but yes, that's what I would do.

Talino · May 22, 2014

Indeed, hi ho Silver!

hotsypatootsie · May 23, 2014

Thank you!! The other mds person insists that it we only need to do the entry then discharge return anticipated assessment because she said we can't bill the day of discharge and then just combine our a admission and 14 day when patient comes back.

Talino · May 23, 2014

You cannot bill for the day of DC but you can bill for the day of adm.

hotsypatootsie · May 23, 2014

That's what I thought...Thank you talino!

hotsypatootsie · Jun 25, 2014

Hello everyone! Hi talino! I'm in a bind...I have a patient who is custodial, went to the hospital , stayed there for 3rd as and came back skilled w/orders for pt/ot, iv antibiotics and Foley for retention. This is not a medicare patient. When res came back, should I do a sig change/ compre? They're saying i should not...but come to think of it if this is a medicare patient we would have done comprehensive assessment on her right? Pls help!!!

Talino · Jun 25, 2014

...but come to think of it if this is a medicare patient we would have done comprehensive assessment on her right? Pls help!!!

The comprehensive (Sig. Change) MDS is only required if the criteria for sig. change is met, regardless of payer. The IDT will have 14 days to determine that. The resident may revert to his usual state after a week or 2 of therapy or completion of AB rx and the catheter eventually d/c'd. Hence, if SCSA for decline is performed initially, you will need another SCSA after for improvement.

hotsypatootsie · Jun 25, 2014

I understand, but this patient was custodial before hospitalization and came back as skilled. Would that not be a big Change on the patient status? It also states in Rai manual that sig change could be major or permanent but not both. Sig change should not be done if the disease process will normally resolve itself even without further intervention m[/size]edically. If the patient has urinary retention would it normally resolve itself without foley? Would his multi organism uti resolve without iv? Would being in therapy now when he was not before a big change by itself? If there is no sig change, why the need for 2 therapy discipline at all?

hotsypatootsie · Jun 25, 2014

Talino i am just really confused! I always thought that mds should reflect "who the patient" is. If I don't do sig change/comprehensive, im afraid i would not be able to capture this event that led him to be skilled in the first place. I appreciate your input. As I said I an new with mds.:) :down:

Talino · Jun 25, 2014

The RAI does not stipulate that a change in level of care, except hospice, warrants SCSA. Every individual is unique. Some may respond to a current treatment quick and some will linger on and even become worse. That's why CMS is generous enough to allow the IDT up to 14 days to determine a sig. change has occured and another 14 days to complete the SCSA. Your clinical notes should be depicting that.

But that should not deter the staff to do one immediately. When unsure, good clinical judgment should be applied. However, if the resident reverts to his normal state, you will have to do another SCSA for improvement.

For some elderly, a 3-day hospital stay with an acute illness is more than enough to debilitate and therapies upon reentry to SNF is warranted. Or, a facility may just want to take advantage of the opportunity to increase the case mix?

hotsypatootsie · Jun 25, 2014

Thank you talino! In the end I guess I would just want to make sure all the docs are in row. I guess I an cynical..I tend to anticipate the worse. oh well I will still do the sig change because I think it will benefit my patient in the long run. What do you think? :)