MDS Alert
Translate Alphabetic ADL Nomenclature To Avoid Upcoding
What's in an alphabetic code for ADLs? Potential problems, if staff don't know precisely what the code means.
Say a facility uses an "A" for assist, a "T" for total or a "D" for dependent.
The CNA may put an "A" for assist but the MDS nurse won't really know how much assistance that means, e.g., a 2 or a 3, so she might overcode it as a 3.
Or a CNA may believe the heavy care she's providing qualifies as a "T" for total. But if the resident participated in some part of his care, the MDS nurse should not code using a 4 for total dependence.
So if a facility decides to stick with the alphabetic codes, ask the CNAs how they are translating the letters into MDS nomenclatures. The best approach is for CNAs to learn and use the actual definitions provided in the Resident Assessment Instrument user's manual.
Source: Cheryl Field, director of clinical and reimbursement services for LTCQ Inc. in Lexington, MA.
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