Question: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: A Significant Change in Status Assessment is required if there are two or more areas of decline or improvement that will not resolve on its own …
Question: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, days billed under Medicare Advantage are subtracted from the resident’s 100-day benefit period. This AAPACN resource …
Question: If a Discharge – return not anticipated was completed for a resident discharge against medical advice (AMA), and he returned less than 30 days later, is a new OBRA Admission assessment required? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA: When the OBRA discharge is named “Return not anticipated” …
Question: A resident has a healing pressure ulcer that was described as “100 % epithelial, with slow blanching erythema” during the ARD window. Would this still be coded as a pressure ulcer? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Code the ulcer as present unless completely healed …
Question: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC:If the supplements were ordered by a physician or physician extender (as allowed in your state) to increase nutrients in the diet …
Question: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: If a Medicare resident discharges to a non-Medicare participating location (home, expires) the same day …
Question: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the physician/extender diagnosed the resident with pneumonia after …
Question: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The Medicare end date would be the date of …
Question: Can we still use dementia as a primary diagnosis for our long-term residents? Our facility was recently told we can no longer use the dementia diagnosis (F03.90) although it maps to medical management? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: If there is no known cause of …
Question: A resident was skilled under Medicare Part A and exhausted benefits. We completed a Significant Change in Status Assessment to capture the improvement before the end of the stay. Should I have completed an IPA or something else with the significant change MDS? Answer from Jessie McGill RN, BSN, …
