Questions & Answers from AAPACN
Browse these industry related questions and answers written by AAPACN’s nurse experts. Find Q&As related to coding, COVID-19 guidance, documentation, and more. These thorough answers and resources are here to help you stay informed on important topics in post-acute care. Want access to all Q&As? Learn more about AAPACN and AAPACN membership.
- Q&A: Can we code respiratory therapy in section O for incentive spirometry with documentation of 15 minutes a day?Question: Can we code respiratory therapy in section O for incentive spirometry with documentation of 15 minutes a day? Answer from Karen White, LPN, RAC-CT: Read through the RAI manual carefully, page 0-18. The therapy must …
- Q&A: If I have a resident who had a Stage 4 pressure ulcer to his coccyx that healed and then six months later it reopened and appears to be a Stage 2, is it still coded as a Stage 4?Question: If I have a resident who had a Stage 4 pressure ulcer to his coccyx that healed and then six months later it reopened and appears to be a Stage 2, is it still …
- Q&A: Is there an interrupted stay policy quick guide for billers that I can use as a reference?Question: Is there an interrupted stay policy quick guide for billers that I can use as a reference? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: AAPACN has a lot of great resources on …
- Q&A: Does AAPACN have any webinars on the changes coming this year with the elimination of G to GG for CNA documentation?Question: Does AAPACN have any webinars on the changes coming this year with the elimination of G to GG for CNA documentation? Answered by Jessie McGill, RN, RAC-MT AAPACN offers an on-demand workshop for section GG, …
- Q&A: Where can I find information about iQIES?Question: Where can I find information about iQIES? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: The Centers for Medicare & Medicaid Services (CMS) recently released the new iQIES Reports User Manual. This manual …
- Q&A: How long can a COVID-19 positive resident who met the criteria of strict isolation be covered under Medicare Part A?Question: How long can a COVID-19 positive resident who met the criteria of strict isolation be covered under Medicare Part A? Answer from Janine Cortesa RN, BSN:Isolation is not a daily skilled need, so that …
- Q&A: If a resident has a chronic urinary tract infection (UTI) and the physician ordered a prophylactic antibiotic, do I code UTI on the MDS as an active diagnosis?Question: If a resident has a chronic urinary tract infection (UTI) and the physician ordered a prophylactic antibiotic, do I code UTI on the MDS as an active diagnosis? Answer from Carol Maher, RN-BC, RAC-MTA, …
- Q&A: We have a resident on Medicare Part A that had a planned discharge return not anticipated to another facility. The resident came back to our facility after 24 hours. What assessments are required?Question: We have a resident on Medicare Part A that had a planned discharge return not anticipated to another facility. The resident came back to our facility after 24 hours. What assessments are required? Answer …
- Q&A: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive?Question: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would refer you …
- Q&A: I have heard different rules on completing OBRA discharge assessments – that an assessment is required if the resident’s head isn’t in the bed at midnight and if the resident is out less than 24 hours, it isn’t necessary. Which is correct?Question: I have heard different rules on completing OBRA discharge assessments. Some say an assessment is required if the resident’s head isn’t in the bed at midnight, others say if the resident is out less …
- Q&A: If the DNS is on the schedule Monday through Friday for 8-hour shifts each day and 40 hours per week, and serves primarily as RN coverage, are they allowed to leave the building for a quick lunch break or something else?Question: If the DNS is on the schedule Monday through Friday for 8-hour shifts each day and 40 hours per week, and serves primarily as RN coverage, are they allowed to leave the building for …
- Q&A: What is the difference between a Stage I pressure injury and a deep tissue injury?Question: What is the difference between a Stage I pressure injury and a deep tissue injury? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: The National Pressure Injury Advisory Panel (NPIAP) defines a stage one …
- Q&A: What assessments are required when a resident ends skilled care under a Managed Care plan and remains in long-term care?Question: What assessments are required when a resident ends skilled care under a Managed Care plan and remains in long-term care? Answer from Janine Cortesa RN, BSN: Typically, there are no MDS assessments to complete …
- Q&A: How is weight loss in the last six months assessed if the resident has only been in the facility for 14 days?Question: How is weight loss in the last six months assessed if the resident has only been in the facility for 14 days? Answer from Jeff Taylor: Looking at the steps for assessment on page …
- Q&A: We missed a first recertification (due by day 14), and we had the physician sign a delayed certification form. When is the next certification due?Question: We missed a first recertification (due by day 14), and we had the physician sign a delayed certification form. When is the next certification due? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
- Q&A: What are some best practices for providing a welcoming and thorough clinical orientation for nurses and unlicensed staff? Question: What are some best practices for providing a welcoming and thorough clinical orientation for nurses and unlicensed staff? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: AAPACNS’s Onboarding Essentials: Welcoming Staff to Promote …
- Q&A: Does anyone have a list of criteria that must be met for a patient to be coded for “at risk for malnutrition” at I5600?Question: Does anyone have a list of criteria that must be met for a patient to be coded for “at risk for malnutrition” at I5600? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: …
- Q&A: For planned discharges, if interviews on the OBRA Discharge assessment have not been completed by the time the resident discharges, do all interview questions need to be dashed?Question: For planned discharges, if interviews on the OBRA Discharge assessment have not been completed by the time the resident discharges, do all interview questions need to be dashed? Answer from Scott Heichel RN, RAC-MT, …
- Q&A: A resident discharged from therapy services, but nursing is educating her on how to perform self-catheterization, which is new for her. How is this coded on the MDS to support skilled care?Question: We have a resident who discharged from therapy services, but nursing is educating her on how to perform self-catheterization, which is new for her. How is this coded on the MDS to support skilled …
- Q&A: What does a facility have to do to maintain compliance if they use bedrails or grab bars?Question: What does a facility have to do to maintain compliance if they use bedrails or grab bars? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: F700 in Appendix PP of the State Operations …
- Q&A: Weight loss was not coded on the prior comprehensive assessment, although it was indicated in the resident’s nutritional assessment. Does this qualify for a significant correction or just a modification?Question: Is a Significant Correction to a Prior Comprehensive (SCPA) required if on the last comprehensive, a Significant Change in Status Assessment (SCSA) in May 2022, the registered dietitian failed to select weight loss on …
- Q&A: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is this a Medicare Part A discharge?Question: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is …
- Q&A: Would this be considered a fall? A staff member reached out to grab a resident as he was losing his balance, but he was able to catch himself by placing a hand down on the bed.Question: Would this be considered a fall? A staff member reached out to grab a resident as he was losing his balance, but he was able to catch himself by placing a hand down on …
- Q&A: How long do facilities have to maintain QAPI records?Question: How long do facilities have to maintain QAPI records? Answer from Alexis Roam, MSN, RN, RN-BC, DNT-MT, QCP-MT: I recommend that you check the facility’s policy on document management to see if QAPI/QAA records …
- Q&A: A resident on a skilled Medicare Part A stay passed away on day seven following admission. Does the 5-Day PPS assessment have to be moved to the day prior to the death in facility (DIF), or can a separate DIF tracking record and a separate 5-Day be set on day seven?Question: A resident on a skilled Medicare Part A stay passed away on day seven following admission. Does the 5-Day PPS assessment have to be moved to the day prior to the death in facility …
- Q&A: A long-term care resident discharged to the hospital on Sept. 20, 2022, and admitted to our facility on Oct. 20, 2022. Is she considered a new admission or readmission?Question: A long-term care resident discharged to the hospital on Sept. 20, 2022, and admitted to our facility on Oct. 20, 2022. Is she considered a new admission or readmission? For the count to determine …
- Q&A: If the assessment reference date is Oct. 20, 2022, and the resident received the influenza vaccine on Oct. 18, 2021, how would I code O0250A?Question: If the assessment reference date is Oct. 20, 2022, and the resident received the influenza vaccine on Oct. 18, 2021, how would I code O0250A? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
- Q&A: I have a resident who has been in the hospital for over 30 days. Do I need to do an admission or reentry tracking record on her return?Question: I have a resident who has been out in the hospital over 30 days. Do I need to do an admission entry and OBRA Admission assessment upon her return? Or do I need to …
- Q&A: Does a nebulizer treatment and post-assessment completed by an LPN meet the criteria to code as respiratory therapy in section O? Or does this need to be completed by an RN?Question: Does a nebulizer treatment and post-assessment completed by an LPN meet the criteria to code as respiratory therapy in section O? Or does this need to be completed by an RN? Answered by Frosini …
- Q&A: Where can I find a list of possible intravenous (IV) solutions that can be administrated for hydration?Question: Where can I find a list of possible intravenous (IV) solutions that can be administrated for hydration? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Almost any IV fluid can be for …
- Q&A: Is a concave mattress considered a restraint?Question: Is a concave mattress considered a restraint? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-CTA, RAC-CT, CPC: According to Appendix PP of the State Operations Manual, a restraint is defined as, “Any manual method or …
- Q&A: Is the 1135 waiver to hire nursing assistants still in effect?Question: Is the 1135 waiver to hire nursing assistants still in effect? There are nursing assistants who were waiting to take the test and have not received their certification that wanted to work and applied …
- Q&A: Is this an interrupted stay?Question: Is this an interrupted stay? A resident newly admits to the facility on 9/21 on a Medicare Part A stay. On 9/23, the resident was sent to the emergency room and was admitted to …
- Q&A: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these changes?Question: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these …
- Q&A: I am completing a Significant Change in Status Assessment (SCSA) for a resident who revoked hospice services. How should I code J1400 since hospice services were provided during the 14-day look-back period?Question: I am completing a Significant Change in Status Assessment (SCSA) for a resident who revoked hospice services. How should I code J1400 since hospice services were provided during the 14-day look-back period? I am …
- Q&A: Are there regulatory requirements regarding the use of outdoor patios by independent residents that should be included in a facility policy?Question: Are there regulatory requirements regarding the use of outdoor patios by independent residents that should be included in a facility policy? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: There is no regulation …
- Q&A: If a resident is diagnosed with COVID-19 and an interim payment assessment (IPA) is completed, does the COVID diagnosis need to be coded at I0020b or I8000?Question: If a resident is diagnosed with COVID-19 and an interim payment assessment (IPA) is completed, does the COVID diagnosis need to be coded at I0020b or I8000? Answered by Melissa Brown, OTR/L, RAC-CT, CDP, …
- Q&A: Can I code a urinary tract infection (UTI) for a new admission from the hospital diagnosis if it’s within the 30-day look-back period?Question: Can I code a urinary tract infection (UTI) for a new admission from the hospital diagnosis if it’s within the 30-day look-back period? Answer by Vicki Gress, RN, RAC-CT: Yes, page I-13 of the …
- Q&A: If a resident goes out to the hospital and then is readmitted to the facility, do we have to complete a baseline care plan upon their readmission within 48 hours?Question: If a resident goes out to the hospital and then is readmitted to the facility, do we have to complete a baseline care plan upon their readmission within 48 hours? Answer by Carol Maher, …
- Q&A: Do residents in Wyoming need to have a two-step Mantoux test upon admission and readmission to a facility if it is in a low-risk area or will screening suffice?Question: Do residents in Wyoming need to have a two-step Mantoux test upon admission and readmission to a facility if it is in a low-risk area or will screening suffice? Answer from Alexis Roam, MSN, …
- Q&A: Can I code psychiatrist visits and orders in MDS items O0600 and O0700?Question: I have been coding psychiatrist visits and orders in MDS items O0600 and O0700. My consultant told me I can’t code this. I thought since a psychiatrist is a medical doctor that specializes in …
- Q&A: When coding K0510A, Nutritional Approach While Not a Resident, can I code IV hydration administered during a surgical procedure on the MDS?Question: When coding K0510A, Nutritional Approach While Not a Resident, can I code IV hydration administered during a surgical procedure on the MDS? Answer by Janine Cortesa, RN, BSN: Coding fluids here is only for …
- Q&A: Can Z codes be used as the primary diagnosis?Question: I was told that, as of the April update of this year, we are no longer allowed to use Z codes as the primary diagnosis. Is this true? Answer by Carol Maher, RN-BC, RAC-MTA, …
- Q&A: Where can I find information for use of CBD products in my facility?AAPACN has a podcast on this topic, CBD Oil Treatment and Care Planning for Nursing Home Residents with Rob Leffler. AMDA provides some information publicly on their website. If your medical director is a member of …
- Q&A: A resident expired at the hospital but was not admitted as an inpatient. Do I need to complete an OBRA Discharge assessment or Death in Facility tracking record?Question: We had a resident code in the facility and was emergency transported to the hospital. The resident expired at the hospital but was never officially admitted to the hospital as an inpatient. Do I …
- Q&A: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate?Question: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate? Answered by Jeff Taylor: This is absolutely false. …
- Q&A: Can a nurse licensed in one state complete sections of the MDS for another state?Question: Can a nurse licensed in one state complete sections of the MDS for another state? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Unless there is a compact between states, the nurse …
- Q&A: Can an LPN/LVN be the infection preventionist for a skilled nursing facility?Question: Can an LPN/LVN be the infection preventionist for a skilled nursing facility? Answer from Denise Winzeler BSN, RN, LNHA, DNS-MT, QCP-MT: Yes, an LPN/LVN can be the infection preventionist as long as they have …
- Q&A: The physician documented “right sided weakness due to CVA,” but did not mention “hemiparesis.” Can I not code “hemiparesis” on the MDS?Question: A resident had a cerebrovascular accident (CVA) and a significant change in status assessment is being completed. The physician documented “right sided weakness due to CVA,” but did not mention “hemiparesis.” Can I not …
- Q&A: We discovered coding errors that go back to 2020. What is the requirement to correct these assessments?Question: We discovered coding errors that go back to 2020, when a resident first enrolled in hospice services. The prior staff member did not code hospice on any MDS assessment from that time and the …
- Q&A: Can a resident be skilled for Medicare Part A and receive hospice care?Question: Can a resident be skilled for Medicare Part A and receive hospice care? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: In order to cover someone on hospice for Medicare A, the …
- Q&A: Do staff have rights when it comes to residents bullying them? How do you manage a resident bully?Answer from Staci Carstens: If a resident is bullying staff, we try to have that staff person avoid that resident or we do double approach with cares. Also, is there an underlying issue with the …
- Q&A: I’m new to MDS. Is there anything that needs to be completed on the MDS before the resident leaves for a planned discharge back to the community?Question: I’m new to MDS. Is there anything that needs to be completed on the MDS before the resident leaves for a planned discharge back to the community? Answered by Kim Steele RN, WCC, RAC-CT, RAC-CTA: …
- Q&A: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Question: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Answered by Jeff Taylor: Here’s a link to the Medicare …
- Q&A: How many days after the due date on a physician recertification can the physician sign and still be in compliance? Question: How many days after the due date on a physician recertification can the physician sign and still be in compliance? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: After the first recertification, …
- Q&A: When can the 1135 waiver be used?Question: When can the 1135 waiver be used? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC: Beginning on page 16, the updated CMS waiver FAQ says the following:Long-Term Care Facilities and Skilled Nursing Facilities (SNFs) …
- Q&A: Are physician certifications required for Medicare Advantage patients?Question: Are physician certifications required for Medicare Advantage patients? Answered by Karen Bernius, PT, RAC-CTA: There are no federal requirements, but you do need to check with the specific HMO/Medicare Advantage plan. We have found …
- Q&A: Is a Significant Change in Status Assessment required if a resident on hospice experiences a decline following a fall?Question: We have a resident that is receiving hospice services who had a fall resulting in a fracture and the family has decided not to treat. The resident now has a decline in function, increased …
- Q&A: A long-term care resident returned from the hospital on a Medicare stay. Can I complete his Quarterly MDS while he is on a skilled level of care?Question: A long-term care resident recently went out to the hospital and returned on a skilled Medicare Part A stay. I have a PPS 5-Day assessment scheduled with an ARD on day 8 of the …
- Q&A: Where can I find information regarding staffing on the AAPACN website?Question: Where can I find information regarding staffing on the AAPACN website? Answer from Scott Hammond: Use the word “staffing” in the search feature on the AAPACN website. This provides the user with various articles …
- Q&A: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days due to a clinical condition. Can he remain on skilled care during those days?Question: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days because his Hemoglobin and Hematocrit were too low and he received blood transfusions. Will the …
- Q&A: When a resident who elected hospice switches to a different hospice company, is a Significant Change in Status Assessment required?Question: When a resident who elected hospice switches to a different hospice company, is a Significant Change in Status Assessment required? Answer from Janine Cortesa, RN: RAI User’s Manual, page 2-23: An SCSA is required …
- Q&A: Can someone clarify the guidelines or protocol to use sepsis as the principal diagnosis in MDS?Question: Can someone clarify the guidelines or protocol to use sepsis as the principal diagnosis in MDS? Answer from Jeff Taylor: This is what I follow from the blog post, “Conquer Coding for Sepsis and …
- Q&A: What can nursing do to improve residents triggering for low-risk incontinence?Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Nursing should complete a thorough assessment, including a 3-day diary recording the times the resident has been incontinent, the times the resident was continent, and …
- Q&A: Has the 3-day qualifying hospital stay waiver expired?Question: Has the 3-day qualifying hospital stay waiver expired? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: It has not. The 3-day qualifying hospital stay waiver is still ongoing; however, many other temporary waivers …
- Q&A: When should a urinary tract infection (UTI) be coded at MDS item I2300?Question: I have a resident with an increase in confusion and a UA with C&S showing >=100,000 CFU/mL of Klebsiella. He has no other noted symptoms and advanced dementia, so he is unable to describe …
- Q&A: Should I complete an interim payment assessment (IPA) for a SNF resident who now tests positive for COVID and is newly receiving isolation for the active infection?Question: I have two residents in my facility that admitted skilled on Medicare Part A and they have since both tested positive for COVID-19. My administrator would like to claim the isolation days and has …
- Q&A: Do 48-hour care plan meetings need to be completed for readmissions?Question: Do 48-hour care plan meetings need to be completed for readmissions? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC [email protected]: Assuming the resident already had the Admission MDS completed on their original …
- Q&A: Does an inpatient rehab stay count toward a qualifying hospital stay for Medicare coverage?Question: We have a referral for a resident with Medicare Part A who has been in an inpatient rehab facility (IRF) for six weeks. Is the IRF still considered acute and can qualify for the …
- Q&A: A Medicare Part A resident was admitted to the hospital and returned to the SNF for a new Medicare stay. Does the diagnosis from the original stay need to be used or can this change?Question: A resident was Medicare Part A with a primary diagnosis of pneumonia. On day 15 of the stay, the resident was admitted to the hospital for five days for atrial fibrillation and hospital acquired …
- Q&A: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay?Question: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay? Answered by …
- Q&A: What does the end of the physician visit waiver mean for SNFs?Question: What does the end of the physician visit waiver mean for SNFs? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT : With the recent QSO memo, QSO-22-15-NH & NLTC & LSC, released April 7, …
- Q&A: We have a resident with indwelling catheter due to urinary retention. The resident also has a history of traumatic intracranial hemorrhage. Am I able to code I1550 (Neurogenic Bladder)?Question: We have a resident with indwelling catheter due to urinary retention. The resident also has a history of traumatic intracranial hemorrhage. Am I able to code I1550 (Neurogenic Bladder)? Answer from Jeff Taylor: No, …
- Q&A: A resident admitted to our facility with a diagnosis of MRSA infection of a wound, receiving oral antibiotics, and in a single room—can I code Isolation in section O?Question: We have a resident who admitted to our facility with a diagnosis of MRSA to a wound and is receiving oral antibiotics. The resident is in a single room by himself. Can I code …
- Q&A: How are therapy services billed when a resident is admitted to the facility for skilled nursing only and hospital documentation recommended outpatient services at home for PT/OT?Question: We have a patient coming to us that the hospital rehab documented they are not appropriate for skilled rehab and recommended home with PT/OT outpatient. However, the physician documented a skilled nursing need to …
- Q&A: Does NHSN have new forms, and if so, what are they?Question: Does NHSN have new forms, and if so, what are they? Answer from Denise Winzeler BSN, RN, LNHA, DNS-MT, QCP-MT: The National Healthcare Safety Network (NHSN) has released new optional forms for tracking and …
- Q&A: My electronic software pulls in ADL documentation, but when I do a final refresh, the ADLs that pull in are inaccurate. Now I must manually verify every ADL. Is there a way to fix this?Question: My electronic software pulls in ADL documentation, but when I do a final refresh, the ADLs that pull in are inaccurate. Now I must manually verify every ADL. Is there a way to fix …
- Q&A: The nursing note states a resident has intermittent shortness of breath with coughing. How would this be coded on the MDS?Question: The nursing note states a resident has intermittent shortness of breath with coughing. How would this be coded on the MDS? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would …
- Q&A: A resident had a fall with fracture and discharged to the hospital on the eighth day following admission. When should the Admission Assessment be scheduled and completed?Question: I have a new resident who fell and broke her hip on the eighth day after admission. The Admission MDS was not completed. She has been discharged to the hospital for surgical repair and …
- Q&A: What is the regulation for how often we should be obtaining vital signs for long-term care residents?Question: What is the regulation for how often we should be obtaining vital signs for long-term care residents? Answer from Alexis Roam, MSN, RN-BC, DNS-CT, QCP: There is not a federal regulation that states a …
- Q&A: If a resident on a Medicare Part A stay goes on a leave of absence for two days, is it considered an interrupted stay? Question: We have a resident who is currently on Medicare Part A receiving skilled services for rehabilitation. His family would like to take him out for a leave of absence (LOA) from Thursday morning to …
- Q&A: If a resident is receiving a full liquid diet due to a recent surgical procedure, is it considered a mechanically altered diet?Question: If a resident is receiving a full liquid diet due to a recent surgical procedure, is it considered a mechanically altered diet? Answer from Debbie Kohn : According to the RAI User’s Manual (p. K-11), …
- Q&A: When a resident is status-post surgery, would that be enough criteria to quality for skilled services?Question: When a resident is status-post surgery, would that be enough criteria to quality for skilled services? Answer from Jeff Taylor: It really depends on the resident’s condition and what services/cares they need. If the resident …
- Q&A: Can a weighted blanket be considered a restraint?Question: Can a weighted blanket be considered a restraint? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: Although the use of a weighted blanket can be a great intervention, if the resident can not …
- Q&A: When a resident was sent to the emergency department (ED) and then later admitted to the hospital, can we code any new diagnoses the resident received in the ED on the discharge assessment? Question: When a resident was sent to the emergency department (ED) and then later admitted to the hospital, can we code any new diagnoses the resident received in the ED on the discharge assessment? For …
- Q&A: Can the three words used in the BIMS interview (sock, blue, and bed) be changed? Can other words be used like shirt, red, and chair?Question: Can the three words used in the BIMS interview (sock, blue, and bed) be changed? Can other words be used like shirt, red, and chair? Half of our team say it must be those …
- Q&A: We just found that we missed some discharge assessments from two years ago. Can these assessments still be completed and submitted?Question: We just found that we missed some discharge assessments from two years ago. Can these assessments still be completed and submitted? Answer from Carol Maher, RN-BC, CPC, RAC-MT: Any missed discharge assessments should be …
- Q&A: Where can I find resources to help me with tracking and trending vaccination data?Question: Where can I find resources to help me with tracking and trending vaccination data? Answer from AAPACN: The Agency for Healthcare Research and Quality (AHRQ) has new vaccination tracking and reporting tools to assist …
- Q&A: What are the criteria to code Malnutrition?Question: What are the criteria to code Malnutrition? Answer from Jeff Taylor: For I5600, I would answer yes if a physician/NP/PA wrote “malnutrition,” “at risk for malnutrition,” or some other diagnostic statement (i.e., marasmus or …
- Q&A: If a resident is discharged before their planned Medicare discharge date, do I open an OBRA Discharge or a Part A PPS Discharge for a new end of Medicare stay?Question: If a resident is discharged before their planned Medicare discharge date, do I open an OBRA Discharge return not anticipated (DCRNA) or do I open a Part A PPS Discharge for a new end …
- Q&A: My software does not allow us to code two digits in the venous/arterial ulcer section on the MDS. How do we code if a resident has more than nine ulcers?Question: My software does not allow us to code two digits in the venous/arterial ulcer section on the MDS. How do we code if a resident has more than nine ulcers? Answer from Carol Maher, …
- Q&A: When does the early-bird registration end for the AAPACN 2022 Annual Conference?Question: When does the early-bird registration end for the AAPACN 2022 Annual Conference? Answer from AAPACN: Registrants must register before March 21, 2022, to receive the early-bird discount. Standard registration is March 21 – April …
- Q&A: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use this code?Question: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use …
- Q&A: Can I code triple antibiotic ointment and/or Bacitracin in section N under antibiotics?Question: Can I code triple antibiotic ointment and/or Bacitracin in section N under antibiotics? Answer from Janine Cortesa RN, BSN: Yes. The RAI states on page N-7 “Include any of these medications given to the resident …
- Q&A: Am I allowed to complete a Significant Change in Status Assessment on a resident who continues to receive hospice services but experienced other unexpected changes?Question: A resident was admitted with hospice services. She improved significantly in her physical functioning, but also worsened significantly in her behaviors. She remains under hospice at this time but is due for review in …
- Q&A: Can a resident take home medications upon discharge?Question: Can a resident take home medications upon discharge? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: Yes, medications can be sent home with a resident upon discharge. Work with your pharmacy provider to …
- Q&A: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19?Question: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19? Answer: The Work Restrictions for HCP Table on the Center for Disease and Prevention’s (CDC) webpage provides information …
- Q&A: If hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query the physician for the subsequent encounter diagnosis to be used in the SNF?Question: If a resident had a hospital stay for hip fracture repair, with no complications documented, and the hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query …
- Q&A: Where can I find resources to assist me with increasing COVID-19 vaccine and booster uptake?There are several great resources for facility leaders to utilize. The Society for Post-Acute and Long-term Care Medicine (AMDA) has several great resources in their COVID-19 Vaccine Education Toolkit. These resources are free to everyone, …
- Q&A: If a mechanically altered diet is being trialed during a speech therapy visit to facilitate oral intake, could K0510C, mechanically altered diet, be coded on the MDS?Question: We are seeking clarification on MDS item K0510C, mechanically altered diet. If a resident is being trialed on a mechanically altered diet or given thickened liquids provided during a speech therapy visit to facilitate …