Q: Our therapist coded too many minutes on the MDS in item P1b—about 2,000 too many. The MDS was submitted to the state, but we caught the error before the billing went out. Do we do a Significant Correction assessment?
A: No, just a modification. The Significant Correction assessment is completed only when an error that misrepresents the clinical status of the resident is identified in an assessment when the error has not already been corrected by completion of a subsequent assessment. The key here is that the Significant Correction assessment has a clinical focus. The PPS assessments (AA8b) are reimbursement assessments and, when they are not combined with a clinical assessment (AA8a), a Significant Correction assessment is never appropriate.
In all cases, errors should be corrected using the modification process (unless the assessment is invalid, in which case it would be inactivated). For clinical assessments that contain major uncorrected errors, the Significant Correction assessment also is required.
For details, see the MDS correction policy, which can be downloaded at http://www.qtso.com/mdsdownload.html.
Rena R. Shephard, MHA, RN, RAC-MT, C-NE
Q: How would you code a resident who was fine for two weeks in the 30-day observation period for E1, Depression, Anxiety, Sad Mood, but also had a 7-day episode in there when she was crying? Would this be a code of 1 or 2? Can you explain the difference? For a code of 2 does the person have to exhibit this behavior almost every day for the last 30 days?
A: The correct coding would be a 1. In order to code a 2 in Section E1, the indicator would need to have been present at least six to seven days for all weeks in the 30-day look-back period. Since the indicator happened daily for only two of the weeks, the correct answer would be a 1.
Carol Maher, RN-BC, RAC-CT
Q: A resident was admitted to our SNF on November 18 at 2 p.m. and discharged against medical advice (AMA) at 9 p.m., less than 24 hours later. I don't have to do the 5-day assessment because we don't bill on discharge day, correct?
A: This is a billable day. I would complete and MDS as much as possible to obtain a RUG or bill at the default. When a resident is admitted and discharged the same day to a nonMedicare provider (such as home) expires, this can be billed. This is the exception to not billing for the day of discharge.
Ronald A Orth, RN, NHA, CPC, RAC-MTraorth@clinicalreimbursement.com
The American Association of Nurse Assessment Coordinators is a nonprofit association of your peers including all members of the interdisciplinary team dedicated to networking, education, and advocacy on behalf of all clinicians involved in the RAI/MDS process. From our online discussion group each week, we select the best questions and answers our members have raised. The questions and answers are reviewed by a national advisory board of experts in this field and are subsequently published in NAC News, AANAC's weekly online newsletter. In addition to our weekly questions and answers, the newsletter contains a variety of timely and accurate information on the RAI/MDS process. AANAC also offers certification and other educational information services for clinicians committed to accurate and timely completion of the MDS. For further information on AANAC, call (800) 768-1880 or visit http://www.aanac.org.