MDS Alert

You won’t find these Section C items in the updated RAI Manual.

Despite promising substantial revisions to the RAI Manual that will turn your MDS coding upside-down, the Centers for Medicare & Medicaid Services (CMS) has at least given you plenty of advance notice on the big changes.

On May 11, CMS posted the new Draft MDS 3.0 RAI Manual v1.14, which will become effective on Oct. 1, 2016. The draft contains new sections, items, and instructions throughout the RAI Manual.

The draft contains nothing that CMS hasn’t already divulged about the upcoming October revisions, so you’ll see the new Section GG, the Section A changes, and so on. Here’s a recap of the major revisions:

Get Ready for New Section GG

The brand new Section GG — Functional Abilities and Goals contains two major items:

• GG0130 — Self-Care; and
• GG0170 — Mobility.

What to expect: In Item GG0130, you will code the resident’s functional status regarding self-care items, including eating, oral hygiene, and toileting hygiene, according to Harmony Healthcare International (HHI). Item GG0170 captures the resident’s functional status regarding mobility, including sitting to lying and lying to sitting on the side of the bed, sitting to standing, various walking skills, and chair, bed and toileting transfers.

Initially, you will code these items on admission to Medicare Part A with an assessment period of one to three days after the start of Medicare dates coded in Item A2400 — Medicare Stay, HHI explains. You’ll complete Section GG with the five-day PPS assessment and the Discharge from Medicare Part A assessments only, and not with any other assessment types.

CMS Replaces Items C1600 & C1300 with Item C1310

Yet another significant revision in the pending RAI Manual update is the deletion of Items C1300 — Signs and Symptoms of Delirium (from CAM^©) and C1600 — Acute Onset of Mental Status Change. CMS will replace these items with the new Item C1310 — Signs and Symptoms of Delirium. CMS also updated the Care Area Assessments (CAAs) for Delirium and Cognitive Status due to these item revisions.

Item C1310 contains the items that you previously coded in C1600 as well as in C1300, except for C1300D — Psychomotor retardation, which is no longer identified for coding, HHI says.

Code New Sub-Item A0310H

The draft MDS 3.0 adds a new sub-item to A0310 — Type of Assessment. Sub-item A0310H — Is this a SNF Part A PPS Discharge Assessment? introduces a new PPS Medicare Part A End of Medicare Stay assessment that has a primary purpose of collecting data for quality reporting, according to HHI.

Old way: When a resident concludes a Medicare Part A covered stay and continues to reside in your SNF, you don’t need to complete any further PPS assessments (although you must continue to follow the OBRA schedule), HHI explains.

New way: Under the new rules, you will need to complete a new PPS Medicare Part A discharge (End of Stay) item set. You must complete this item set when you code A0310H as 1 — Yes.

Pay Attention to Section M Additions

Also, CMS is adding the items in M0300 — Current Number of Unhealed Pressure Ulcers at Each Stage (specifically, M0300B through M0300G) to the Nursing Home Discharge and the new Medicare Part A End of Stay assessments. Although you currently code these items on the comprehensive, quarterly, and PPS item sets, CMS will add these to All Discharge and End of Medicare item sets.

Link: You can find the Draft MDS 3.0 RAI Manual v1.14 at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html. Scroll to the bottom of the page and find the draft in the Related Links section.