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glm777's Latest Activity

  1. glm777

    Hospice and the MDS

    I have 2 questions 1. If a resident goes on Hospice but dies 2 days after the ARD (day 8)does the MDS still have to be done? Usually if the resident is d/c before the due date of, for example, an annual MDS, we close it out and write a note saying why it wasn’t completed. But I’m being told that Hospice regulations are different from regs for a regular MDS and a Hospice MDS must still be completed. Makes no sense to me! No one will benefit from it and he no longer needs a plan of care! 2. If a resident is on Hospice and goes out to the hospital section 12(unrelated to Hospice), and returns to the facility 5 days later, and continues on Hospice starting on his readmission date, must a change of status MDS be completed? Thank you!
  2. glm777

    need clarification regarding GDR documentation

    Another thought: If the resident had a GDR say on 10/31/19, but had a risk vs. benefit note stating a reduction in med was contraindicated on 3/31/19, do you still code "Yes" for N0450D?
  3. "In N0450B and N0450C, include GDR attempts conducted since the resident was admitted to the facility" Back to original admission date or most recent re-entry date? Also, our pharmacy puts a note in the chart documenting that a GDR is due. They include in the note a paragraph that states "a GDR attempt is likely to impair this individual's function or cause psychiatric instability by exacerbating an underlying medical condition or psychiatric disorder AS DOCUMENTED BELOW" On the line below, our MDs/psych service usually document : needs meds for stability. needs for schizophrenia. needs for yelling/agitation. Is this adequate for GDR contraindication documentation? Can this be considered a true "risk vs. benefit" statement? I have read and re-read the RAI manual multiple times. In your opinion, would you code that statement, as documented above, as a "yes" in section N 0450D - "Physician documented GDR as clinically contraindicated" ? I appreciate everyone's opinion!
  4. glm777

    UTI timeline

    UTI coding question: The 30 day timeline - is it required that the DIAGNOSIS of UTI be within the past 30 days or TREATMENT of the UTI within the past 30 days? current ARD 8/30 diagnosed 7/27 ( not within past 30 days) with all appropriate requirements treated 7/27 through 8/6 (treated within past 30 days) Should UTI be coded?? I have read and re-read the RAI manual and feel it is not clear. Thank you!
  5. glm777

    Section N0450B - GDR

    How do you all interpret this question? Since there is no time frame associated with the question - how far back are you going? I have residents on Antipsychotics who have been here 10 years. Thanks for your input.
  6. glm777

    hospital observation stay

    we admitted a resident who spent 4 days in the hospital on an observation stay - never actually admitted. He went to the hospital from home. Should I code him as admitting from community or hospital?
  7. glm777

    CP meeting sign in sheets

    I am looking for a new sign in sheet for our CP meetings. Can folks share what their facilities use?
  8. glm777

    disenrolloment from Hospice

    A resident was admitted under hospice services. On day 12 he decided to disenroll from Hospice. I have not completed the admission assessment yet. I believe i would have to code Hospice in section O on the admission assessment but please tell me i dont need a sig change right after that to show disenrollment. Thanks!
  9. glm777

    psych unit in acute care hospital

    If a resident had a voluntary psych admission to a dedicated geri psych unit of our local acute care hospital, what would you code A1800 - "entered from" when he returned? Acute care hospital or psychiatric hospital? Thank you!
  10. glm777

    ICD 10 coding of Primary diagnosis

    What do you use for your primary diagnosis code for new admissions? Some are saying use the diagnosis for the reason they are coming to the nursing home, others are saying use the diagnosis for which they went into the hospital. Example: admitted to hospital with peripheral artery disease due to DM Required above the knee amp Came to us for surgical aftercare Will have rehab and return home Which diagnosis would you use for your "primary admitting diagnosis"? Thank you!!
  11. glm777

    Adm MDS completion

    That is how we have always interpreted the RAI manual. However in a recent focused MDS survey, we received deficiencies for late Admission MDSes and were told that the manual states that the admission MDS must be completed within 14 days without condition and that only AFTER the admission assessment is complete does the "new 14 day" rule apply if the resident is MLOA during an assessment period. Per the manual: If a resident had an OBRA Admission assessment completed and then goes to the hospital(discharge return anticipated and returns within 30 days) and returns during an assessment period and most of the assessment was completed prior to the hospitalization, then the nursing home may wish to continue with the original assessment, provided the resident does not meet the criteria for a SCSA. In this case, the ARD remains the same and the assessment must be completed by the completion dates required of the assessment type based on the timeframe in which the assessment was started. Otherwise, the assessment should be reinitiated with a new ARD and completed within 14 days after reentry from the hospital. The portion of the resident's assessment that was previously completed should be stored on the resident's record with a notation that the assessment was reinitiated because the resident was hospitalized. Also: • Federal statute and regulations require that residents are assessed promptly upon admission (but no later than day 14) and the results are used in planning and providing appropriate care to attain or maintain the highest practicable well-being. This means it is imperative for nursing homes to assess a resident upon the individual's admission. The IDT may choose to start and complete the Admission comprehensive assessment at any time prior to the end of day 14.
  12. glm777

    Adm MDS completion

    Can someone please clarify the completion timeframe for an admission assessment if the resident goes out to the hospital with the first 14 days? I have a resident who was admitted then went out to the hospital on day 2 - was in the building approx 20 hours. We discharged him return anticipated since he was expected to return to us. Resident returned on day 14. Does my admission assessment still need to be completed by day 14? I would only have 20 hours of documentation to complete my MDS with. But per a recent MDS audit my company had, if the resident is in the building on day 14, the MDS must be completed. What if he had returned on day 16? When would my MDS be due then?
  13. glm777

    ADL coding question

    Coding in transfers is as follows: supervision - X 4 Limited assist X 2 Extensive assist X 1 Totally dependent X1 Independent x 13 I believe we should code transfers as supervision as that is the only code that occurred 3 or more times (other than Independent, which is the exception)and it follows the sequence of coding rules per the RAI manual. My colleague feels we can code transfers as an extensive assist by using the algorithm. I was under the impression you only go to the algorithm if there is no qualifying code that occurs more than three times. Would love to hear everyone's opinion!
  14. glm777

    Coding I & D of gangrene

    I have a patient who required emergency I & D in the OR for Fournier's Gangrene of the scrotum. The RAI notes that Surgical debridement of a PRESSURE ULCER should not be coded as a surgical wound but does not mention any other type of wound in the same regard. It is draining and requires packing. Would you code this a surgical wound?
  15. glm777

    gabapentin as scheduled pain med

    Do you code meds like Gabapentin, Lyrica and Neurontin as pain meds in section J? In this particular case they are being used to treat neuropathy and chronic pain syndrome. The manual says to not code the med if it used to treat the underlying cause of the pain but by treating the underlying cause it is also preventing the reoccurrence of the pain, which is a goal of pain management meds. Looking forward to hearing what others think. My 2 consultants have differing opinions. Thanks
  16. glm777

    Rule of three

    But isn't that only if there are not three of any one code? In this case there are more than three instances of supervision.

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