need opinions please - ANOTHER consultant!

[glm777, BSN, RN]

As usual, a new consultant in the building with her own interpretaion of the RAI manual.

A few questions:

Resident has Gtube but only being flushed - no feedings (taking PO) - ? code "feeding tube" in sect K

Resident has bowel movement 3x/week - each time is incont - ? code "3" or "4" for section H

Resident struck by car - ? code as a "fall" in section J

Surgical wound w/o treatment but order to check qshift for s/sx infection - ? code "sx wnd care" in sect M

I've looked at all these in the RAI manual and have my own opinion (that has never gotten us a tag) but this new consultant is challenging my coding. Would love to have the opinions of others.

Thanks!

[rapkeygurl]

well I tell you what I would do , first I ask the DON, check the manual , then I call the RNC, if I still dont get a clear answer on something I send an email to the state mds coordinator. I sent a letter yesterday b/c the administrator said you can not have all the people in your building with fall risks.. I can not wait to show him the email tomorrow I got back from her lol. what I really liked is that she said the MDS is not the only tool you use to assess problems and even if the fall risk did not trigger there are other things you can look at. I went to a great seminar last week that was to help us to look for what the surveyor will look for they suggest to careplan risks, disease process and previous fall or previous wound should always be careplanned

[Talino]

resident has gtube but only being flushed - no feedings (taking po) - ? code "feeding tube" in sect k

yes, code still as a feeding tube. the definition specifies its presence, not whether the tube is used or not. the fluids flushed, despite a small volume, should be included in calculating a resident's daily fluid intake.

resident has bowel movement 3x/week - each time is incont - ? code "3" or "4" for section h

the lookback is 14 days. if all bms in the last 14 days the resident was incontinent, code "4". to code "3", there must have been an episode of continence at least once a week.

resident struck by car - ? code as a "fall" in section j

a fall is a fall regardless of cause. falling down after being struck by a vehicle is similar to a fall after being pushed, except for the degree of force that caused the fall.

surgical wound w/o treatment but order to check qshift for s/sx infection - ? code "sx wnd care" in sect m

the definition states, "includes any intervention for treating or protecting any type of surgical wound." these would refer to physical contact of the wound, as the examples represent. "checking" is simply observing or assessing.