Talino

Neither a Q or SCSA are valid assessments when an Admission has never been completed. If the resident has no consecutive 14 days of stay, you can reschedule the Adm MDS and complete it within 14 days upon ReEntry. You will get a warning when submitted, simply ignore it.

Per medical texts, being labeled schizoaffective means having both psychotic and mood symptoms (major depressive or bipolar). Manic depression only refers to mood symptoms, hence, ruled out.

The guideline suggests 2 or more areas of ADL improvement warrants a SCSA. If you have 2, then yes. The weight gain is an expected outcome with which the resident made steady progress under the current course of care (physician-prescribed weight gain) so I will exclude it in the guideline for SCSA improvement. The ST becomes relevant to the SCSA if an actual problem is identified and a change is recommended, otherwise it simply was precautionary.

The Sig Change overrides the Quarterly. The Sig Change also resets the OBRA schedule, meaning a Quarterly is due on or before 92 days after the SCSA, and the Annual is due on or before 366 days after the SCSA.

Advance Directives for Behavioral Health

If the ARD of the Adm MDS is prior to the hospice disenrollment, the SCSA will be required. I will just move the Adm ARD to the day of disenrollment and refocus on one CAA and care plan. Just make sure it's completed by day 14.

The Admission assm't is not required. If Med A eligible, a 5-day would be needed.

Under the hospice program benefit regulations, a physician is required to document in the medical record a life expectancy of less than 6 months, so if a resident is on hospice the expectation is that the documentation is in the medical record. RAI, pJ-24 Only then will you code J1400 = 1

The quarterly is due 92 days from the last OBRA assm't (in your case a quarterly). Hence the next assm't (if a quarterly) would be due on July 8th. OBRA schedules are located in the RAI pp 2-16 to 2-18.

Acute hospital. A psych hospital is a stand alone facility.

Yes you can combine the quarterly on 5/18. Unfortunately only a dash (not assessed) applies to the interviews. Since you have up to the ARD to conduct interviews, you can document - "Interviews due but not completed by 5/18. Resident transferred to hospital." On the other hand, you can schedule the quarterly on return (maybe a Sig change too). If resident received IVF or IV med in hospital, you can capture them within the required time frame.

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Yes..

The Adm MDS is not required. Depending on what the payor requires, you may need to complete a 5-day (not submitted) to obtain the HIPPS code to bill.

If there is no behavior issue coded in E and no hallucination or delirium identified, don't enter a dx for behavior disturbance. To be active it should be evidenced-base.