MDS Alert

Understand when A1600 and A1900 stay the same or change.

The much-needed clarifications on Entry/Reentry MDS coding from the Centers for Medicare & Medicaid Services (CMS) are certainly a big help. But CMS didn’t stop there — you also get some fresh scenarios to further illustrate how to code items A1600 through A1900.

In the February RAI Manual revisions, CMS added four new examples to clarify coding for items A1600, A1700, A1800, and A1900. The new examples appear in Chapter 3, Section A, on page A-25.

Keep A1600 & A1900 the Same for New Admissions

Example 1: Mrs. H was admitted to your facility from an acute care hospital on Sept. 14, 2013 for rehabilitation after a hip replacement. You now must complete her Admission assessment.

How to code: For the Entry Date in item A1600, you would enter 09/14/2013. Code A1700 as 1 — Admission, and then choose code 03 — Acute hospital for item A1800 — Entered From. Enter 09/14/2013 as the Admission Date in A1900.

New Admission or Reentry?

Example 2: Mrs. H was a former resident at your facility who was discharged home return not anticipated on Nov. 2, 2013, after a successful recovery and rehabilitation. A discharge planner at an acute care hospital informed your facility that Mrs. H was admitted to the hospital on Feb. 8, 2014 and wished to return to your facility for rehabilitation after hospital discharge. Mrs. H returned to your facility on Feb. 15, 2014.

How to code: Although Mrs. H was a resident of your facility in September 2013, she was discharged home return not anticipated; therefore, you would consider her as a new admission and you would code as follows when completing her Admission assessment:

• A1600 = 02/15/2014
• A1700 = 1 — Admission
• A1800 = 03 — Acute hospital
• A1900 = 02/15/2014

When Reentry Continues Current Stay

Example 3: Mr. K was admitted to your facility on Oct. 5, 2013 and was discharged return anticipated to the hospital on Oct. 20, 2013. He returned to your facility on Oct. 26, 2013. Since Mr. K was a resident of your facility, was discharged return anticipated, and returned within 30 days of discharge, you would consider Mr. K as continuing his current stay. So when you complete his Entry Tracking Record upon return from the hospital, you would code as follows:

• A1600 = 10/26/2013
• A1700 = 2 — Reentry
• A1800 = 03 — Acute hospital
• A1900 = 10/05/2013

One month after his return, Mr. K was again sent to the hospital, return anticipated, on Nov. 5, 2013. He returned to your facility on Nov. 22, 2013. Again, because Mr. K was a resident of your facility, was discharged return anticipated, and returned within 30 days of discharge, you would consider him as continuing his current stay. So you would complete his Entry Tracking Record as follows:

• A1600 = 11/22/2013
• A1700 = 2 — Reentry
• A1800 = 03 — Acute hospital
• A1900 = 10/05/2013

Code Admission Even in This Case

Example 4: On Aug. 26, 2014, Ms. S was admitted to your facility for rehabilitation after a total knee replacement. Three days after admission, Ms. S spiked a fever and nursing staff observed increased drainage, reddening, swelling and extreme pain at her surgical site. Your facility sent Ms. S to the emergency room and completed her Discharge assessment as return anticipated. The hospital called your facility to inform you that Ms. S was admitted. 

One week into her hospitalization, Ms. S developed a blood clot in her affected leg, further complicating her recovery. The hospital then contacted your facility to readmit Ms. S for rehabilitation services following discharge from the hospital, which occurred on Oct. 10, 2014. 

Even though Ms. S was a former patient in your facility’s rehabilitation unit and was discharged return anticipated, she did not return within 30 days of discharge to the hospital. Therefore, you would consider Ms. S a new admission to your facility. On her return, when you complete her Admission assessment, you would code as follows:

• A1600 = 10/10/2014
• A1700 = 1 — Admission
• A1800 = 03 — Acute hospital
• A1900 = 10/10/2014