MDS Alert

Several MDS items confirm a comatose state.

Coding a resident's comatose state goes beyond simply recording a "1" at B1.

For starters, you need a physician-documented "neurological diagnosis of coma or persistent vegetative state" to code someone as having that condition at B1.

There's more: Simply coding a resident as a "1" at B1 for being in a comatose or persistent vegetative state isn't enough. The RUGs definition of comatose is as follows, says Peter Arbuthnot, in Jackson, MS:

B1 = 1
N1a, b and c (time awake) = 0

Late-loss ADL self-performance scores (G1aA, G1bA, G1hA, G1iA) = 4 or 8

Don't be fooled: "A person in a persistent vegetative state as diagnosed by the physician may appear to be awake if his eyes are open," says Nancy Augustine, MSN, RN, a consultant with LTCQ Inc. in Lexington, MA. "But you don't code that as time awake" at N1, she advises. People diagnosed as being in a persistent vegetative state have a neurological exam showing extensive damage to both cerebral hemispheres, according to the RAI manual.

Perform this cross-check: Make sure you didn't mistakenly code a comatose resident as participating in his activities of daily living, suggests Augustine.