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As I said earlier, this is prefectly logical
clinical reasoning, but the MDS is not only a clinical device. It is a payment
device and with I2e we are talking about a PPS item. The after-effects of
pneumonia are not going to justify a RUG score in the clinically complex group.
Nathan
----- Original Message -----
Sent: Tuesday, February 17, 2004 6:43
AM
Subject: Re: Dave Audit
The coding problem remains when you have a resident whose acute pneumonia
is resolved (off antibiotics and has a "clean" xray), but who is still
receiving rehab for the after-effects of the pneumonia. In a real sense,
the pneumonia diagnosis still is "related to current functional, medical, and
clinical status." (from AANAC manual, MDS 2.0 Coding for OBRA and PPS, page
177.) The AANAC manual continues, "Diseases and diagoses are
important considerations for rehabilitiation services, medications, and
other treatment protocols. Thus, important care planning issues arise
from this section. For Medicare Part A reimbursement, diagnoses that
justify the resident's coverage must appear on the MDS and the medical record
face sheet as well as on the UB-92 claim form..." Though the pneumonia
is clinically resolved, for the nurses and therapists, it is still an issue
that drives care planning and therapy decisions. Because of this, it
makes sense to us to include it on the MDS. The (MDS) Long term Care RAI
User's Manual, does not specify that active infection must be present during
the lookback, it asks the coder to identify conditions that have "a
relationship to current ADL status, cognitive status...medical treatment,
nursing monitoring..." Our argument is that the pneumonia still has this
relationship and should be included on the MDS until is is fully resolved,
i.e. no longer impacting ADL...nurse monitoring..... Please
comment!
[EMAIL PROTECTED] wrote:
Section I2 is asking if there was an infection
present during the observation period.
Rena
Rena R. Shephard,
MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
Subj: Re: Dave Audit
Date: 2/16/04 3:54:05 AM
Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to:
[EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the
Internet
In a message dated 2/15/04 9:15:19 PM Eastern
Standard Time, [EMAIL PROTECTED] writes:
I guess it's a different way of thinking about it...my
argument is that the aftereffects of the infection are obviously
secondary to that infection, and therefore per the instructions for I2
are still affecting the resident functional status so the condition is
not completely resolved and should be coded. Does this make
sense?
RNCATFL
This makes total
sense to me. The MDS doesn't always reflect
nursing practice as evidenced by the way pressure ulcers are
scored.. You Never downstage a pressure ulcer .. except on
the MDS:) And what we are trying to capture is functional
ability, so what you are saying is the way I see it also.
PJ
Caroline Larson, RN, MS, RAC-C
MDS/PRI Coordinator
Fairport Baptist Homes, Fairport, NY 14450
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