MDS Alert

A resident's ability to communicate affects the Cognitive Performance Scale.

Most people think of Section C as driving care planning and safety issues--not payment. But undercoding a resident's ability to make himself understood (C4) can cost you. Why? The RUG grouper considers C4 in calculating the resident's score on the Cognitive Performance Scale, which can affect his RUG placement within the Extensive Services category--or in Impaired Cognition.

A score of 3 or higher flags a resident as cognitively impaired for RUG placement purposes. But in some cases, if a resident has impaired daily decision making (B4) and you miscode him as a "0" for easily understood" at C4, he won't get a score of 3 on the CPS, cautions Peter Arbuthnot, an RUG software expert in Jackson, MS.

What you should do: Code a resident as "1" for "usually understood" if he has "difficulty finding the right words or finishing thoughts, resulting in delayed responses"--or if the resident requires prompting to make himself understood, instructs the RAI manual.

Why people get it wrong: A caregiver who becomes accustomed to how a resident communicates may not realize she's completing the person's sentences or intuiting what the person needs, adds Arbuthnot. But you shouldn't code that resident at C4 as "0" for easily understood. To get a more objective view of the resident's communication, ask someone who doesn't know the resident very well to assess the resident's ability to make himself understood, suggests Pam Campbell, RN, with LTC Solutions in Cape Girardeau, MO.

Tip: A resident assessed at C4 as "3" (rarely/never understood), should not necessarily be coded as severely impaired in daily decision-making at B4, cautions the RAI manual. "The two areas of function aren't always associated." Instead, assess the reason for the person's communication issue (for example, does he speak a foreign language or is he profoundly hard of hearing?). Do a more thorough assessment of the person's cognitive functioning.