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Restorative Nursing:

Know What Counts As Restorative For Coding Section P3

Published on Mon Mar 21, 2005

Use this checklist of requirements.

To provide restorative nursing is one thing, but coding it in Section P3 of the MDS is another.

To do the latter, the facility must offer restorative care that meets requirements spelled out by the RAI user's manual. Restorative care includes "nursing interventions that assist or promote the resident's ability to attain his or her maximum functional potential," according to the manual. Section P3 does not include procedures or techniques carried out by or under the direction of qualified therapists, as identified in item P1b.

In addition, to be included in Section P3, restorative care must meet the following criteria:

  •   Measurable objectives and interventions must be documented in the care plan and in the clinical record.

  •   Evidence of periodic evaluation by a licensed nurse must be present in the clinical record.
     
  •   Nurse assistants/aides must be trained in the techniques that promote resident involvement in the restorative activity. 
     
  •   The activities are carried out or supervised by members of the nursing staff. 

    Keep in mind that the nursing focus is actually greater than provision of the restorative services per se, which may actually be provided by CNAs, activities personnel and even volunteers under the supervision of the licensed nurse, says Cheryl Field, MSN, RN, with LTCQ Inc. in Lexington, MA. Restorative nursing programs require a skilled nurse to evaluate the program and add treatments, as needed, she adds. "The restorative services are really interventions aimed at a bigger problem," Field sums up  - for example, ADL decline that's impacting the resident's functional and health status. To review the restorative services in Section P3 and coding directions, go to www.cms.hhs.gov/quality/mds20/raich3.pd(pp.3-192-195).

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