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I have a different coding question:
Many OTs continue to use debility as their
supporting ICD-9 rehab. diagnosis. Anyone out there have a better code? I used
to know a code for decline in functional abilities but cannot locate. I have an
04 AMA code book but am having difficulty navigating it. I would appreciate any
help out there. Thanks in advance.
Gail Neustadt, NHA
----- Original Message -----
Sent: Friday, March 19, 2004 2:23
PM
Subject: Re: Coding Pain
The reference to the resident's goal for pain
management being met was deleted with the August 2003 update of the RAI User's
Manual. You can download the updated manual at http://www.cms.hhs.gov/medicaid/mds20/man-form.asp
The
manual instructions are to code for the presence of pain (determined based on
assessment of the resident's reports of pain and professional assessment of
presence of pain) regardless of pain management interventions. If the
resident had pain during the observation period, code it in J2. If the
resident had no pain, then J2a=0, no pain.
Scenario: A resident
is on pain meds. Had no pain at all for 6 days of the observation
period. Had pain at moderate level one time on the 7th day, relieved
within 2 hours with prn pain med. J2a=1, pain less than daily.
J2b=2, moderate pain.
Scenario: A resident is on pain meds.
Has pain on a daily basis, at mild level, except once during the observation
period, the resident has breakthrough pain at moderate level, receives prn
med, pain returns to baseline within 1 hour. J2a=2, pain daily.
J2b=2, moderate pain.
Scenario: A resident is on routine pain
meds for back pain. During the observation period, the resident had no
pain at any time. J2a=0, no pain.
Rena
Rena R. Shephard,
MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
Subj:
Date: 3/19/04 9:44:39 AM Pacific Standard
Time
From: [EMAIL PROTECTED]
Reply-to:
[EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
I am still confused about coding for pain
management. In one reply this past week one person stated that if pain
med is effective and relieving pain then they code 0. I always thought
if they had pain you code it. I talked with another MDS coordinator in
my area and she states that if the pain regime is controlling the pain you
code 0 even though they have pain at times. In the RAI mannual it
states The Resident's goal for pain management is being met. So if
thier pain level is under thier ALOP could you code a 0. Lots of times
these Residents do not fully understand thier acceptable level of pain
or the pain scale. I am confused again as to how to understand if
thier goal for pain management is being met. She also mentioned
that someone from Qualis Care explained it to her this way. So the way
we learn to code our pain is effecting our scores on Nursing Home Compare
even if we are coding wrong. So these compares may not be
accurate. I would appreciate if someone could help clarify this
problem again as I am confused . Thanks Mary
Lynn
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