Medicare Compliance & Reimbursement

Get ready for a whole new Section I with MDS 3.0.

Take one look at Section I in the proposed MDS 3.0, and you'll see big changes afoot. New diagnoses with checkboxes have been added, some diagnoses have been removed, and there are several new spots for ICD-9 codes. What does it all mean for coders?

Expect Less Coding

The proposed MDS 3.0 takes into account a common occurrence in SNFs, says Rena Shephard, RN, MHA, FACDONA, president of RRS Healthcare Consulting in San Diego and founding chair and executive editor of the American Association of Nurse Assessment Coordinators. MDS nurses are handed an ICD-9 coding book and told to do the coding, she says. But ICD-9 coding is a specialty area that requires significant training, she points out.

Key: ICD-9 coding, including selecting the principle diagnosis, additional diagnoses and the sequencing, is important for the UB92 claim form. But on the MDS, the coding is subordinate to identifying what the diagnoses actually are, says Shephard.

In developing MDS 3.0, the experts tried to determine which diagnoses they needed to include as checkboxes to help alleviate some of the burden of coding for them, says Shephard.

Look For Guidance On Active Diagnoses

Another challenge for those completing Section I has been deciding which diagnoses qualify as active. The instructions for MDS 3.0 aim to help make these decisions more black and white, says Shephard.

A goal for MDS 3.0 is to develop algorithms to provide guidance for whether a diagnosis meets the MDS definition of "active," says Debra Saliba, MD, MPH, associate professor at UCLA and a researcher for the Rand Corporation's national validation study of the draft MDS 3.0 items.

For example: For arthritis to qualify as an active diagnosis, the MDS 3.0 draft instructions require that you have a physician-documented diagnosis of arthritis in the last 60 days, plus one or more of the following items in the past 30 days:

• specific documentation by a physician indicating that the arthritis is an active disease;

• a positive test, study or procedure;

• signs and symptoms;

• current medications and treatment.

Add 'Other' Codes By Body System

MDS 3.0 adds a blank for ICD-9 codes in each body system. These blanks allow the facility to create a complete list of diagnoses in Section I as an accurate representation of the resident's clinical status, says Shephard. If there is no checkbox for a particular condition, these blanks provide a place to put it.

When rehab is covering a resident on part A, their diagnoses are sometimes aftercare codes, and there aren't a whole lot of options for that on the MDS itself, says Shephard. In the Musculoskeletal section of MDS 3.0 you'll see checkboxes for "hip fracture," and "other fracture," and a blank for another musculoskeletal ICD-9 code. This blank is an opportunity to add another diagnosis that is active, but isn't on the list.

For example: A resident was admitted to your SNF following hospital treatment for a fracture of the femur. The diagnosis V54.89 (Other orthopedic aftercare) is likely to be appropriate if he is receiving physical therapy. Since this diagnosis does not appear on the MDS, you would add it in one of the blank spaces.

Check For 'Missing' Diagnoses

If you compare MDS 2.0 to 3.0, you'll see some check boxes missing, says Saliba. Those are things that were being screened for in other places on the MDS, so they've been removed from Section I to reduce redundancy, she says. This change was based on feedback from MDS 3.0 working groups. If feedback from the testing of the new MDS indicates that these diagnoses should be added back into Section I, you may see them return.

For example: Impaired vision is screened for in Section B: Hearing, Speech, and Vision, so these conditions aren't included in Section I.