MDS Alert

Question: How do I correctly document our facility’s efforts when a resident requires isolation to prevent infections spreading to other residents? Does isolation affect reimbursement?

Oregon Subscriber

Answer: Make sure you have the documentation in the respective resident’s clinical record that shows that isolation is a medical necessity, which, according to the Resident Assessment Instrument (RAI) Manual, means that the resident meets all of the following conditions, outlined on page O-5:

“The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.

“Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.

“The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.

“The resident must remain in his/her room. This requires that all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.).”

Whether you should code isolation for all residents in the midst of a pandemic is a bigger question: Does a new standard level of precaution requiring isolation mean facilities should document and be reimbursed accordingly?