RE: Coding Pain

[Debbie Settle]

You only do an OMRA if resident remains on Medicare after ALL rehab has been discontinued. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Gail Neustadt Sent: Monday, March 22, 2004 9:32 PM To: [EMAIL PROTECTED] Subject: Re: Coding Pain I have another couple of questions. I know that OMRA has been discussed repeatedly, but I cannot remember...If therapy is the last service to skill a resident and the resident was a RMC at the 30 day MDS, then discharged from therapy 35, should an OMRA be done in 8, 9, o r10 days? Also, is anyone out there doing outcome studies? If so, are you collecting data by hand, using a program or any other methods? Thanks   Gail Neustadt, NHA ----- Original Message ----- From: Priscilla Bullard To: [EMAIL PROTECTED] Sent: Saturday, March 20, 2004 4:46 PM Subject: RE: Coding Pain The recommendation in Coding Clinic in 99 was to code the manifestation of the debility- such as gait problems, muscle weakness, etc. There are new �04 codes for both �difficulty walking� and �muscle weakness�.  Another new code to look at could be rhabdomyolysis,   Look at the AfterCare of Fracture codes- the V54 series, V57.1 which is a new code for gait training. There are lots of codes for different types of arthritis or pain. If you have a specific ongoing dx question, Gail, then email me back privately.  There is a �Decrease in functional activity�, which is coded as 780.99�.but this is a pretty unspecific code. Anyway, email me back and I�ll bring my coding books home on Monday.   Cil Bullard RN, CPC   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Gail Neustadt Sent: Saturday, March 20, 2004 3:04 PM To: [EMAIL PROTECTED] Subject: Re: Coding Pain   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 ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] 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