MDS Alert

Question: We have a temp MDS nurse helping with assessments, and she says that other facilities where she’s worked count standard admission orders as physician orders. I’ve never done that and always thought it was incorrect to do so. Who’s right?

New York Subscriber

Answer: The Centers for Medicare & Medicaid Services (CMS) doesn’t require MDS item O0600 (Physician orders) but some states do. Standard admission orders should not be considered physician orders, per the RAI Manual O-51.

Per the RAI Manual, physician orders include includes orders written by “medical doctors, doctors of osteopathy, podiatrists, dentists, and physician assistants, nurse practitioners, clinical nurse specialists, qualified dietitians, clinically qualified nutrition professionals or qualified therapists, working in collaboration with the physician as allowable by state law.”

The orders can be written, telephoned, faxed, or consultation orders for new or altered treatment but does not include standard admission orders, return admission orders, renewal orders, or clarifying orders without changes. If an order written on the day of admission is updated to encapsulate any unexpected changes or resident injuries, it can be considered new or altered treatment orders and should count as an order change in the lookback period.

The RAI Manual also specifies that standard admission orders are prohibited even when the orders are given and received at different times than the date of admission.