MDS Alert

Test your knowledge of the April 2012 RAI changes.

Following a stroke, Mrs. F. was admitted to the skilled nursing facility in stable condition for rehabilitation therapy on 10/6/11 under Part A skilled nursing facility coverage. She had slurred speech, difficulty swallowing, severe weakness in both her right upper and lower extremities, and a Stage III pressure ulcer on her left lateral malleolus. She was referred to SLP, OT, and PT with the long-term goal of returning home with her daughter and son-in-law. Her initial SLP evaluation was performed on 10/06/11, the PT initial evaluation on 10/07/11, and the OT initial evaluation on 10/09/11. She was also referred to recreational therapy and respiratory therapy. The interdisciplinary team determined that 10/19/11 as an appropriate ARD for her Medicare-required 14-day MDS. During the look-back period she received the following:

Speech-language pathology services that were provided over the 7-day look-back period.

• Individual dysphagia treatments; Monday-Friday for 30-minute sessions each day.
• Cognitive training; Monday and Thursday for 35-minute concurrent therapy sessions and Tuesday, Wednesday, and Friday 25-minute group sessions.
• Individual speech techniques; Tuesday and Thursday for 20-minute sessions each day.

Occupational therapy services that were provided over the 7-day look-back period:

• Individual sitting balance activities; Monday and Wednesday for 30-minute co-treatment sessions with PT each day (OT and PT each code the session as 30 minutes for each discipline).
• Individual wheelchair seating and positioning; Monday, Wednesday, and Friday for the following times: 23 minutes, 18 minutes, and 12 minutes.
• Balance/coordination activities; Tuesday-Friday for 20 minutes each day in group sessions.

Physical therapy services that were provided over the 7-day look-back period:

• Individual wound debridement followed by application of routine wound dressing; Monday the session lasted 22 minutes, 5 minutes of which were for the application of the dressing. On Thursday the session lasted 27 minutes, 6 minutes of which were for the application of the dressing. For each session the therapy aide spent 7 minutes preparing the debridement area (set-up time) for needed therapy supplies and equipment for the therapist to conduct wound debridement.
• Individual sitting balance activities; on Monday and Wednesday for 30-minute co-treatment sessions with OT (OT and PT each code the session as 30 minutes for each discipline).
• Individual bed positioning and bed mobility training; Monday-Friday for 35 minutes each day.
• Concurrent therapeutic exercises; Monday-Friday for 20 minutes each day.

Respiratory therapy services that were provided over the 7-day look-back period:

• Respiratory therapy services; Sunday-Thursday for 10 minutes each day.

Psychological therapy services that were provided over the 7-day look-back period:

• Psychological therapy services were not provided at all over the 7-day look-back period.

Recreational therapy services provided over the 7-day look-back period.

• Recreational therapy services; Tuesday, Wednesday, and Friday for 30-minute sessions each day.

Answers:

O0400A1 would be coded 190; O0400A2 would be coded 70; O0400A3 would be coded 75; O0400A4 would be coded 5; O0400A5 would be coded 10062011; and O0400A6 would be coded with dashes.

Individual minutes totaled 190 over the 7-day look-back period [(30 x 5) + (20 x 2) = 190]; concurrent minutes totaled 70 over the 7-day look-back period (35 x 2 = 70); and group minutes totaled 75 over the 7-day look-back period (25 x 3 = 75). Therapy was provided for 5 out of the 7 days of the look-back period. Date speech-language pathology services began was 10-06-2011, and dashes were used as the therapy end date value because the therapy was ongoing.

O0400B1 would be coded 113; O0400B2 would be coded 0, O0400B3 would be coded 80; O0400B4 would be coded 5, O0400B5 would be coded 10092011, and O0400B6 would be coded with dashes.

Individual minutes totaled 113 over the 7-day look-back period [(30 x 2) + 18 + 12 = 113]; concurrent minutes totaled 0 over the 7-day look-back period (0 x 0 = 0); and group minutes totaled 80 over the 7-day look-back period (20 x 4 = 80). Therapy was provided 5 out of the 7 days of the look-back period. Date occupational therapy services began was 10-09-2011 and dashes were used as the therapy end value because the therapy was ongoing.

O0400C1 would be coded 287; O0400C2 would be coded 100; O0400C3 would be coded 0; O0400C4 would be coded 5; O0400C5 would be coded 10072011; and O0400C6 would be coded with dashes.

Rationale:

Individual minutes totaled 287 over the 7-day look-back period [(30 x 2) + (35 x 5) + (22 ��" 5) + 7 + (27 --" 6) + 7 = 287]; concurrent minutes totaled 100 over the 7-day look-back period (20 x 5 = 100); and group minutes totaled 0 over the 7-day look-back period (0 x 0 = 0). Therapy was provided 5 out of the 7 days of the look-back period. Date physical therapy services began was 10-07-2011, and dashes were used as the therapy end date value because the therapy was ongoing.

O0400D1 would be coded 50; O0400D2 would be coded 0.

Total minutes were 50 over the 7-day look-back period (10 x 5 = 50). Although a total of 50 minutes of respiratory therapy services were provided over the 7-day look-back period, there were not any days that respiratory therapy was provided for 15 minutes or more. Therefore, O0400D equals zero days.

O0400E1 would be coded 0; O0400E2 would be coded 0. (Editor's note: These instructions, found on Page O-28 of the April 2012 RAI User's Manual contradict the instructions on the MDS and the depiction found on Page O-30, which indicate that O0400E2 should be left blank (skipped) in this example. MDS Alert has brought this inconsistency to the attention of John Kane, health insurance specialist with CMS' Division of Institutional Post Acute Care, but at press time was still awaiting clarification.)

There were no minutes or days of psychological therapy services provided over the 7-day look-back period.

O0400F1 would be coded 90; O0400F2 would be coded 3.

Rationale:

Total minutes were 90 over the 7-day look-back period (30 x 3 = 90). Sessions provided were longer than 15 minutes each day, therefore each day recreational therapy was performed can be counted.