MDS Alert
Know How to Code Pain Meds at J0100A and J0100B
Can you code PRN meds if the resident refused them?
How should we code a resident who is receiving a regularly scheduled opioid medication regimen for cancer pain and also PRN pain medication for break-through pain during the lookback?
Answer:
Code J0100A ("been on a scheduled pain medication regimen") as "1" for Yes, the routine pain medication was received, advises Marty Pachciarz, RN, director of clinical services for the Polaris Group in Tampa, Fla. You would code J0100B ("received PRN pain medication") as a "1" for Yes, the PRN drugs were offered and received. "PRN pain meds can also be coded 'Yes,' if offered and declined."
The coding instructions verbatim from the RAI User's Manual are as follows:
"J0100A, Been on a Scheduled Pain Medication Regimen
1. Code 0, no: if the medical record does not contain documentation that a scheduled pain medication was received.
2. Code 1, yes: if the medical record contains documentation that a scheduled pain medication was received.
J0100B, Received PRN Pain Medication
1. Code 0, no: if the medical record does not contain documentation that a PRN medication was received or offered.
2. Code 1, yes: if the medical record contains documentation that a PRN medication was either received OR was offered but declined."
Is the New Medicare Wellness Exam an Option for Nursing Home Residents?
Question:
Can long-term care residents who are private pay or Medicaid and have Part B receive the new Medicare annual wellness exam? If so, what are the requirements in terms of who can provide the wellness visit?
Answer:
"The annual wellness exam can be completed on an annual basis for all Medicare Part B participants," says Deb Philips, RN, RAC-CT, director of regulatory affairs for the Polaris Group in Tampa, Fla. "This can be completed in a skilled nursing facility by a nurse practitioner and does not replace the regulatory required visits in a SNF."
According to a CMS MLN Matters article, the following providers can perform the annual wellness visit:
A physician (doctor of medicine or osteopathy)
A physician assistant, nurse practitioner, or clinical nurse specialist
A medical professional, which includes "a health educator, registered dietitian, or nutrition professional or other licensed practitioner or a team of such medical professionals, working under the direct supervision of a physician ..."
The exam includes screening for cognitive impairment and risk factors for depression, as well as an effort to come up with a recommended preventive screening program for the patient.
"An annual wellness exam focused on prevention and assessing cognition can be very valuable -- if people do it," says Diana Waugh, RN, BSN, a consultant in Waterville, Ohio.
For more information about coverage and billing, see the MLN Matters article at http://www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf.
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