MDS Alert
Would You Code Abnormal Labs At P9 For These Residents?
Question No. 1: Mrs. Smith receives warfarin (Coumadin) for a recent bout of thrombophlebitis. Mrs. Smith's prothrombin times are abnormally elevated but in the therapeutic range for her. Would you code "1" for "yes" at P9 that Mrs. Smith has abnormal lab values?
1. No, because anticoagulation testing is excluded from P9.
2. No, because even though her prothrombin times are elevated, they are therapeutic for her.
3. Yes, the prothrombin times are abnormal even though that's the desired effect.
Question No. 2: Mr. Jones has diabetes mellitus and receives finger-sticks for blood glucose testing. His glucose was recorded as being abnormally high one time 50 days ago (from the assessment reference date for the MDS). Would you code him as having abnormal lab values?
1. No, you don't include finger-stick blood tests in coding P9.
2. Yes, his glucose has been abnormal and you do include results obtained via finger-sticks.
3. No, because Mr. Jones' abnormal glucose results occurred outside the 30-day lookback period for P9.
Question No. 3: Mr. Adams was admitted to the SNF two weeks ago. His lab values have been normal since, but he had electrolyte imbalances in the hospital a week before admission to the SNF. Would you code him as having abnormal lab values at P9?
1. Yes, you count hospital lab results in the lookback.
2. No, P9 refers only to laboratory tests performed after admission to the nursing facility.
Coding Quiz Answers:
Question No. 1: The answer is option 3. An elevated prothrombin time in a resident receiving Coumadin therapy is coded "1" for "yes," even though this may be the desired effect, according to the RAI user's manual. "Abnormal" refers to laboratory values that are abnormal when compared to standard values, not abnormal for a particular resident.
Question No. 2: The answer is option 2. Abnormal blood glucose levels, including levels obtained via finger-sticks are included in this item, states the RAI user's manual. The lookback for coding P9 is 90 days or since admission. You code "1" for yes (abnormal) if the resident has had at least one abnormal lab value.
Question No. 3: The answer is option 2. Item P9 refers only to laboratory tests performed after admission to the nursing facility, according to the RAI user's manual.
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