# Need help!!!

1. I am looking for help from a very experienced MDS nurse. I am working in long term care as an MDS coordinator but I was trained on the job, never certified. I quit doing it for about 1 1/2 years but now I have started up again. At this new jobs b I feel like I am being asked to code things incorrectly. They are not wanting anyone to to have a RUG that is an A, B and C only. I have some questions I'd like to ask someone that is experienced in MDS. Thank.

Joined: Dec '15; Posts: 6

3. No matter how much you read the RAI, there will likely be a situation you thought you knew but didn't. Bring up a scenario and we can all dissect the answer.

"experienced MDS nurse" is moot. Just post your question and we'll share the best we can.

Welcome!
4. My main thing right now is coding issues. When I read the RAI it states what is set up and what is extensive and so on. When I read the RAI it says removing tray covers and cutting food and buttering bread is all set up. But where I work they want us to code this as a 2/2. And I use therapy notes as well as CNA and nursing charting but all they really seem to have us focus on is therapy evaluations. I was hoping to find out if there is a book or website that ead more user friendly than the RAI.
5. removing tray covers and cutting food and buttering bread is all set up
You are correct. However, this is only one part that is unfolded, Support Provided is Eating = X/1.

Now, how was the food/drink delivered to the resident's mouth (Self-performance)?
If X = 0 or 1, then 0/1 and 1/1 are the only valid answers.
If X = 2, 3, or 4, then 2/1, 3/1, & 4/1 are illogical answers.

In a nut shell, if the ADL self-performance is limited, there must have been at least 1 person who provided support. Hence Eating = 2/2

Incorrect ADL coding is the most common culprit of incorrect reimbursement. That 1 point ADL Sum difference can bring you up or down a RUG category. You can either be underpaid or overpaid.

You are also correct in relying on documentations to code the MDS. Let Admin realize before you change the coding, the documentations must change first if they are incorrect and the staff reeducated.

have us focus on is therapy evaluations
Rehab yields the most reimbursement. Some long term residents may benefit therapy to maintain or regain function which some of us may assume - "they're old, it's what they are, and what they're gonna be"

I was hoping to find out if there is a book or website that ead more user friendly than the RAI
I am not aware of a so-called "MDS 3.0 For Dummies" although for years I've always mused of authoring one. But, the incessant revisions bog me down There are also ADL coding instructions in youtube. However, only the RAI Manual can explain the ADL coding in details.
6. There's no changing the rules of the RAI, so where you need to look is at the ADL documentation. We all know that there is ALWAYS inaccuracies with ADL coding. When I see coding that doesn't seem right I head straight to the direct caregivers. I ask very specific questions about care provided. Most of the time I do find that they have not taken credit for the care they provided. The CNAs know if I am walking down the hall I will be watching them and asking questions. It may sound tedious, but completely worth it in the end. I also pull the nurse managers into my education. ADL coding requires continuing education and monitoring; however, your work will pay off in the end.