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Coding Quizzer:

How Would You Code These Pain Assessment Interview (J0300-J0600) Examples?

Published on Mon May 14, 2012

J0300 Pain Presence (5-Day Look Back)

RAI Manual Coding Instructions:

"Code for the presence or absence of pain regardless of pain management efforts during the 5-day look-back period.

Code 0, no: if the resident responds 'no' to any pain in the 5-day look-back period. Code 0, no: even if the reason for no pain is that the resident received pain management interventions.

Code 1, yes: if the resident responds 'yes' to pain at any time during the look-back period.

Code 9, unable to answer: if the resident is unable to answer, does not respond, or gives a nonsensical response."

RAI Manual Coding Tips:

"Rates of self-reported pain are higher than observed rates. Although some observers have expressed concern that residents may not complain and may deny pain, the regular and objective use of self-report pain scales enhances residents' willingness to report."

RAI Scenarios: J0300 Pain Presence

Scenario No. 1: "When asked about pain, Mrs. S. responds, 'No. I have been taking the pain medication regularly, so fortunately I have had no pain.'"

Scenario No. 2: "When asked about pain, Mr. T. responds, 'No pain, but I have had a terrible burning sensation all down my leg.'"

Scenario No. 3: "When asked about pain, Ms. G. responds, 'I was on a train in 1905.'"

See the answers on page 59 of this issue.

J0400 Pain Frequency (5-Day Look Back)

RAI Manual Coding Instructions:

"Code for pain frequency during the 5-day look-back period.

Code 1, almost constantly: if the resident responds 'almost constantly' to the question.

Code 2, frequently: if the resident responds 'frequently' to the question.

Code 3, occasionally: if the resident responds 'occasionally' to the question.

Code 4, rarely: if the resident responds 'rarely' to the question.

Code 9, unable to answer: if the resident is unable to respond, does not respond, or gives a nonsensical response."

RAI Manual Coding Tips:

"No predetermined definitions are offered to the resident related to frequency of pain.

--The response should be based on the resident's interpretation of the frequency options.

--Facility policy should provide standardized tools to use throughout the facility in assessing pain to ensure consistency in interpretation and documentation of the resident's pain."

RAI Scenarios: J0400 Pain Frequency

Scenario No. 1: "When asked about pain, Mrs. C. responds, "All the time. It has been a terrible week. I have not been able to get comfortable for more than 10 minutes at a time since I started physical therapy four days ago."

Scenario No. 2: "When asked about pain, Miss K. responds, "I can't remember. I think I had a headache a few times in the past couple of days, but they gave me acetaminophen and the headaches went away." The interviewer clarifies by echoing what Miss K. said: "You've had a headache a few times in the past couple of days and the headaches went away when you were given acetaminophen. If you had to choose from the answers, would you say you had pain occasionally or rarely?" Miss K. replies, "Occasionally."

Scenario No. 3. "When asked about pain, Ms. M. responds, "I would say rarely. Since I started using the patch, I don't have much pain at all, but four days ago the pain came back. I think they were a bit overdue in putting on the new patch, so I had some pain for a little while that day."

See the answers on page 59 of this issue.

J0500 Pain Effect on Function (5-Day Look Back)

RAI Coding Instructions for J0500A, Over the Past 5 Days, Has Pain Made It Hard for You to Sleep at Night?

"Code 0, no: if the resident responds 'no,' indicating that pain did not interfere with sleep.

Code 1, yes: if the resident responds 'yes,' indicating that pain interfered with sleep.

Code 9, unable to answer: if the resident is unable to answer the question, does not respond or gives a nonsensical response."

RAI Scenarios: J0500A Effect of Pain on Ability to Sleep

Scenario No. 1: "Mrs. D. responds, 'I had a little back pain from being in the wheelchair all day, but it felt so much better when I went to bed. I slept like a baby.'"

Scenario No. 2: "Mr. E. responds, 'I can't sleep at all in this place." The interviewer clarifies by saying, 'You can't sleep here. Would you say that was because pain made it hard for you to sleep at night?' Mr. E. responds, 'No. It has nothing to do with me. I have no pain. It is because everyone is making so much noise.'"

Scenario No. 3: "Miss G. responds, 'Yes, the back pain makes it hard to sleep. I have to ask for extra pain medicine, and I still wake up several times during the night because my back hurts so much.'"

See the answers on page 59 of this issue.

RAI Coding Instructions for J0500B, Over the Past 5 Days, Have You Limited Your Day-to-day Activities because of Pain?

"Code 0, no: if the resident indicates that pain did not interfere with daily activities.

Code 1, yes: if the resident indicates that pain interfered with daily activities.

Code 9, unable to answer: if the resident is unable to answer the question, does not respond or gives a nonsensical response."

RAI Scenarios: J0500B Effect of Pain on Daily Activities

Scenario No. 1: "Ms. L. responds, 'No, I had some pain on Wednesday, but I didn't want to miss the shopping trip, so I went.'"

Scenario No. 2: "Mrs. N. responds, 'Yes, I haven't been able to play the piano, because my shoulder hurts.'"

Scenario No. 3: "Mrs. S. responds, "I don't know. I have not tried to knit since my finger swelled up yesterday, because I'm afraid it might hurt even more than it does now."

Scenario No. 4: "Mr. Q responds, 'I don't like painful activities.' Interviewer repeats question and Mr. Q. responds, 'I designed a plane one time.'"

See the answers on page 59 of this issue.

J0600 Pain Intensity (5-Day Look Back)

RAI Coding Instructions for J0600A: Numeric Rating Scale (00-10)

"Enter the two digit number (00-10) indicated by the resident as corresponding to the intensity of his or her worst pain during the 5-day-look-back period, where zero is no pain, and 10 is the worst pain imaginable. Enter 99 if unable to answer."

RAI Scenarios: J0600A Numeric Rating Scale

Scenario No. 1: "The nurse asks Ms. T. to rate her pain on a scale of 0-10. Ms. T. states that she is not sure, because she has shoulder pain and knee pain, and sometimes it is really bad, and sometimes it is OK. The nurse reminds Ms. T. to think about all the pain she had during the last 5 days and select the number that describes her worst pain. She reports that her pain is a '6'."

Scenario No. 2: "The nurse asks Mr. S. to rate his pain, reviews use of the scale, and provides the 0-10 visual aid. Mr. S. says, 'My pain doesn't have any numbers.' The nurse explains that the numbers help the staff understand how severe his pain is, and repeats the '0' end is no pain and the '10' end is the worst pain imaginable. Mr. S. replies, 'I don't know where it would fall.'"

RAI Manual Coding Instructions for J0600B: Verbal Descriptor Scale

"Code 1, mild: if resident indicates that his or her pain is 'mild.'

Code 2, moderate: if resident indicates that his or her pain is 'moderate.'

Code 3, severe: if resident indicates that his or her pain is 'severe.'

Code 4, very severe, horrible: if resident indicates that his or her pain is 'very severe or horrible.'

Code 9, unable to answer: if resident is unable to answer, chooses not to respond, does not respond or gives a nonsensical response."

RAI Scenarios: J0600B Verbal Descriptor Scale

Scenario No. 1: "The nurse asks Mr. R. to rate his pain using the verbal descriptor scale. He looks at the response options presented using a cue card and says his pain is 'severe' sometimes, but most of the time it is 'mild.'"

Scenario No. 2: "The nurse asks Ms. U. to rate her pain, reviews use of the verbal descriptor scale, and provides a cue card as a visual aid. Ms. U. says, 'I'm not sure whether it's mild or moderate.' The nurse reminds Ms. U. to think about her worst pain during the last 5 days. Ms. U. says 'At its worst, it was moderate.'"

Source: Excerpted verbatim from the Long-Term Care Facility Resident Assessment Instrument User's Manual MDS 3.0, V1.08 (April 2012).

Coding Quizzer Answers:

How Would You Code These Pain Assessment Interview (J0300-J0600) Examples?

Are you a super-coder? Check your coding results here.

J0300 Pain Presence (5-Day Look Back)

Scenario No. 1: Mrs. S. reports having no pain during the look-back period. Even though she received pain management interventions during the look-back period, the item is coded 0, no, because there was no pain.

Scenario No. 2: Although Mr. T.'s initial response is 'no,' the comments indicate that he has experienced pain (burning sensation) during the look-back period, so the item is coded 1, yes.

Scenario No. 3: Ms. G. has provided a nonsensical answer to the question, so the item is coded 9, unable to respond, and the assessor will complete the Staff Assessment for Pain beginning with Indicators of Pain item (J0800).

J0400 Pain Frequency (5-Day Look Back)

Scenario No. 1: Mrs. C. describes pain that has occurred 'all the time,' so the item is coded 1, almost constantly.

Scenario No. 2: After the interviewer clarified Miss K.'s choice using echoing, the resident selected a response option, so the item is coded 3, occasionally.

Scenario No. 3: Ms. M. selected the 'rarely' response option, so the item is coded 4, rarely.

J0500A Pain Effect on Ability to Sleep (5-Day Look Back)

Scenario No. 1: Mrs. D. reports no sleep problems related to pain, so item is coded 0, no.

Scenario No. 2: Mr. E. reports that his sleep problems are not related to pain, so item is coded, 0, no.

Scenario No. 3: Miss G. reports pain-related sleep problems, so item is coded 1, yes.

J0500B Pain Effect on Daily Activities (5-Day Look Back)

Scenario No. 1: Although Ms. L. reports pain, she did not limit her activity because of it, item is coded 0, no.

Scenario No. 2: Mrs. N. reports limiting her activities because of pain, so item is coded 1, yes.

Scenario No. 3: Mrs. S. avoided a usual activity because of fear that her pain would increase, so item is coded 1, yes.

Scenario No. 4: Mr. Q. has provided a nonsensical answer to the question, so item is coded 9, unable to answer.

J0600A Pain Intensity Numeric Rating Scale (5-Day Look Back)

Scenario No. 1: Ms. T. said her pain was 6 on the 0 to 10 scale, because a 2-digit number is required it is coded 06.

Scenario No. 2: Mr. S. was unable to select a number or point to a location on the 0-10 scale the represented his level of pain intensity, so item is coded 99, unable to answer. The interviewer would go on to ask about pain intensity using the Verbal Descriptor Scale item J0600B.

J0600B Pain Intensity Verbal Descriptor Scale (5-Day Look Back)

Scenario No. 1: Mr. R. said his worst pain was 'severe', so the item is coded 3, severe.

Scenario No. 2: Ms. U. indicated that her worst pain was 'moderate,' so the item is coded 2, moderate.

Editor's Note: All answers have been excerpted from the Long-Term Care Facility Resident Assessment Instrument User's Manual MDS 3.0, V1.08 (April 2012).

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