IV medications on MDS

Specialties Geriatric


Advise--On a 5 day PPS patient, I record on the MDS if indicated from the residents recent hospitalization that they had an IV (the records from the hospitalization show the date/ and what medication was given). Now on the 14 day, if the resident isn't getting any therapy ( I am at liberty to choose my ARD date for the 14 day), by counting back it can place them back in the hospital, and I have a copy of the IV administration in the chart? Can you mark again IV medication again? I am not counting any hydration/flushes etc. Thanks Tex:cool:


1,010 Posts

Specializes in ER CCU MICU SICU LTC/SNF.

The question is ...

Is there a skilled nursing need for this resident as a result of that IV rx, i.e., daily nursing observation to watch for adverse effects related to or as a result of the IV rx or the drug used?

If so, make sure you have it well documented. A care plan is your best bet.

Be wary... since you'll be paid from from day 15 to 30, this skilling need may not be realistic after 2-3 weeks of IV rx. Hence you'll be compelled to terminate coverage before the 30th day.


155 Posts

So what you are saying is that, on the 14 day assessment, from the ARD date, when counting back, if they were placed back in the hospital at the time, I can't use it. The residents that this were indicated for this, came off pps, and no 30 day was done. Thanks Tex

I was taught that you cannot take credit for hospital services on the 14-day assessment. I code the special services on the 5-day, which pays us for 14 days of skilled observation, and drop them on the 0/7 or 1/7, if they were not continued in the SNF. As Talino says, the 14-day will pay you from day 15 on, so you shouldn't expect to be paid for what happened 15 days earlier.........

I should also say that you mentioned your residents weren't getting any therapy. If the special services from the hospital are the only thing that kept them in a reimbursable category, you have to drop them after day 14.

In my state, we still have to do "tracking" MDS for the full 100 days, even if they've been dropped, due to a very aggressive state advocacy board that will challenge anyone dropped before day 100.

I'm starting at an ICF next week--no Medicares (not a case mix state, either)...whatever will I do with myself? :)


155 Posts

Thanks catlady this helps me, I continue to learn tex


79 Posts

I think you could still count the IV med from the Hospital on the 14 day, if it fell within the time frame for the assessment. Nothing in the manual says to use them only for 5 day assessments. The instructions (PP3-148)say to identify treatment the resident recieved in the specified time period. The question of skilled need shouldn't control what you answer on the MDS. Just answer the questions as they are written. Unless there is clarification from State and Feds that I am unaware of. You should be reviewing you coverage weekly as the resident must be recieving a daily skilled service you can't wait for a new MDS. Do you submit these "tracking " MDS's?? Does every facility in your state do this? I would think this would be an unnecessary assessment. The state and feds frown on this.

We do tracking MDS and submit them, just not include them in billing PPS. This way, if the state wins its appeal, and Medicare has to pay after we've dropped them, we have completed assessments, done on time, and get paid at the proper RUGS rate, rather than the default rate.

Catsrule16, RN

114 Posts

Look at the instructions for that section of the MDS. I believe it reads "or since the last assessment." If you completed an assessment for 5 day, you can't count the IV's on the 14 day. Past the window of observation.


79 Posts

catsrule, you're correct. thanks for pointing it out. Catlady, if you dropped someone from Medicare, how would medicare be responsible to pay ? I am assuming you have given the resident a denial letter. If this is the case, the facility eats this cost. You can't go back and bill medicare when you have already denied services. Course, I could be misunderstanding what you're talking about.

Yes, Fran, even though a denial letter will have been sent, if the state wins its appeal, the facility goes back and rebills the stay as Medicare, based on the Medicare tracking assessments which are done as if the resident was never denied. The denial letter actually gets torn up, if you can believe it. The state is appealing based on their hope that the resident was actually receiving skilled services, and was wrongly denied Medicare. Because all the assessments will have been done in a timely manner and the nurses will have continued to document for the full 100 days of eligibility, Medicare has to pay at the regular rate, not the default rate.


15 Posts

Wow! You guys are making my head spin. I'm kind of new to this, and I thought you COULD count the hospital IV on the 14 day; in fact, I HAVE before. I believe that resident was also receiving skilled therapies, tho, so hopefully it will be ok.

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