MDS Alert

Question: I have a resident admitting from the hospital with multiple diagnoses: dementia, chronic obstructive pulmonary disease (COPD), and a year-old knee replacement. There are a lot of codes to include, but I’m not sure which is most appropriate as the primary diagnosis. All of the resident’s conditions require dedicated nursing care. The resident’s family has said that the dementia is hard to deal with emotionally — the resident will be on our memory care wing — and the resident will also require respiratory therapy for the COPD.

Ohio Subscriber

Answer: The key thing to keep in mind is the word “primary”  — which of these diagnoses actually sent the resident to the hospital? Even if the resident has multiple medical conditions and diagnoses, the Centers for Medicare & Medicaid Services (CMS) wants to know the reason the resident ends up in the nursing facility. In this case, with the resident leaving a private, family living situation to be admitted to the nursing facility to receive respiratory therapy, the dementia is an important aspect of care but not the primary reason for admittance. For MDS item I0020, you’d select Code 12, Debility, Cardiorespiratory Conditions because the COPD is the diagnosis requiring respiratory therapy and, thus, nursing care in the facility.

This is where accuracy matters and the coding gets tricky. It is not necessarily your responsibility as the nurse assessment coordinator to decide which diagnosis is the primary diagnosis.

If there is no clear or definitive active primary diagnosis, you should query the physician, says Carol Maher, Rn-BC, RAC-CT, RAC-Mt, CPC, clinical consultant at Hansen Hunter & Co. P.C., in Vancouver, Washington.