MDS Alert

Question: I don’t understand when to code that a resident has constipation versus fecal impaction. Where’s the line?

Missouri Subscriber

Answer: You can think of fecal impaction as a chronic issue stemming from constipation — which is often the result of other conditions. Remember, the two phrases are not synonymous.

The RAI Manual defines the respective terms accordingly:

Constipation: “If the resident has two or fewer bowel movements during the 7-day look-back period or if for most bowel movements their stool is hard and difficult for them to pass (no matter what the frequency of bowel movements).”

Fecal impaction: “A large mass of dry, hard stool that can develop in the rectum due to chronic constipation. This mass may be so hard that the resident is unable to move it from the rectum. Watery stool from higher in the bowel or irritation from the impaction may move around the mass and leak out, causing soiling, often a sign of a fecal impaction.”

While fecal impaction can be a serious condition, the MDS asks only about constipation in item H0600 (Bowel Patterns). If a resident is living with constipation, as evidenced by their own reporting (if reliable), their medical record, progress notes, physician notes, or interviews with direct care staff, make sure to investigate potential causes, like medication side effects or dehydration.