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: Please clarify when a device would or would not be considered a restraint?Question: Can a winged versus a concave mattress be considered a restraint if it fits the definition? Can a tilt and space wheelchair be considered a restraint? It is being explained to me that it …
- Q&A: If a resident on a Medicare Part A stay expires the same day as admission, is it a billable day?Question: If a resident on a Medicare Part A stay expires the same day as admission, is it a billable day? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC:Yes, if a Medicare A …
- Q&A: A long-term resident has had a feeding tube for more than 10 years. He exhausted Medicare Part A benefits years ago. Can he be skilled with the new G-tube placement?Question: A long-term resident has had a feeding tube for more than 10 years. He exhausted his Medicare Part A benefits years ago. He recently experienced recurrent aspiration and had an extended hospitalization with a …
- Q&A: Is there a requirement regarding how abuse training is completed?Question: Is there a requirement regarding how abuse training is completed? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT:CMS requires education on certain topics for new and existing staff, specifically, training on abuse, neglect, …
- Q&A: What staff member in a skilled nursing facility (SNF) can complete data collection and entry for section GG items?Question: What staff member in a SNF can complete data collection and entry for section GG items? Answer from Melissa Brown, OTR/L, RAC-CT, CDP, CSRS: I think what may be causing confusion here is the …
- Q&A: If a Medicare Part A resident goes on a therapeutic leave of absence (LOA) of four days for a funeral, what MDS assessments/records, if any, are required?Question: If a Medicare Part A resident goes on a therapeutic leave of absence (LOA) of four days for a funeral, what MDS assessments/records, if any, are required? Answer from Jeff Taylor: No additional MDS …
- Q&A: Can a comprehensive MDS be completed before day 14, such as on day 9 or 10, as long as it is completed by day 14?Question: Can a comprehensive MDS be completed before day 14, such as on day 9 or 10, as long as it is completed by day 14? For example, we have a 5-Day combined with an …
- Q&A: Where can I obtain CMS training regarding the new MDS guidelines?Question: Where can I obtain CMS training regarding the new MDS guidelines? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP: The Centers for Medicare & Medicaid Services (CMS) has developed a two-part, training program …
- Q&A: Would therapy 5 times a week prevent a 60-day wellness period?Question: I have a resident who had a recent 3-day qualifying stay for Medicare Part A. He had exhausted all benefits in January but continued to have Medicare Part B therapy 5 days a week for …
- Q&A: When coding section E (Behaviors), does this need to be supported by episode charting in the medical record for each behavior or does this require progress notes stating what behavior occurred?Question: When coding section E (Behaviors), does this need to be supported by episode charting in the medical record for each behavior or does this require progress notes stating what behavior occurred? Answer from Jeff …
- Q&A: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically Complex. Is this a software error?Question: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically …
- Q&A: How do I receive my continuing education credits for the sessions I attended at the 2023 AAPACN Conference?Question: How do I receive my continuing education credits for the sessions I attended at the 2023 AAPACN Conference? Answer from Alix Murrell: To receive your CE certificate, you must fill out the online form …
- Q&A: Where do I find the Five-Star reports in iQIES?Question: Where do I find the Five-Star reports in iQIES? Answer from Kim Steele RN, WCC, RAC-CT, RAC-CTA: It can’t be accessed in iQIES at this time. You will continue to access some reports or …
- Q&A: We have a resident who was in our facility in 2017 and then returned as a new admission this year. We noted her last name was misspelled on all assessments in 2017. Can I modify these assessments?Question: We have a resident who was in our facility in 2017 and then returned as a new admission this year. We noted her last name was misspelled on all assessments in 2017. Our billing …
- Q&A: A resident had a fall at home that resulted in a fracture but did not receive surgery. The provider’s progress notes indicated, “Unspecified fall, initial encounter” (W19.XXXA), as the primary medical diagnosis. Should I use this diagnosis?Question: A resident had a fall at home that resulted in an acetabular fracture but did not receive surgery. The provider’s progress notes indicated, “Unspecified fall, initial encounter” (W19.XXXA), as the primary medical diagnosis. Should …
- Q&A: The look-back period for J1800 is for falls since admission/entry or reentry or prior assessment (OBRA or scheduled PPS), whichever is more recent. For this look-back, is the Part A PPS Discharge assessment considered a “scheduled PPS” assessment?Question: The look-back period for J1800 is for falls since admission/entry or reentry or prior assessment (OBRA or scheduled PPS), whichever is more recent. For this look-back, is the Part A PPS Discharge assessment considered …
- Q&A: If a resident’s BIMS interview cannot be completed, when is it appropriate to code C0100, “Should the Brief Interview for Mental Status be Conducted?” as “No”? Question: If a resident’s BIMS interview cannot be completed, when is it appropriate to code C0100, “Should the Brief Interview for Mental Status be Conducted?” as “No”? Surveyors asked about our rationale for coding resident …
- Q&A: A resident on Medicare Part A went out on a leave of absence (LOA) for a temporary home visit on Saturday and returned on Monday. How do we bill this?Question: A resident on Medicare Part A went out on a leave of absence (LOA) for a temporary home visit on Saturday and returned on Monday. How do we bill this? Answer from Carol Maher, …
- Q&A: Should a complaint of rough handling during care involve a complete abuse investigation, even if they have cognitive impairment?Question: Should a complaint of rough handling during care involve a complete abuse investigation, even if they have cognitive impairment? Answer from Denise Winzeler BSN, RN, LNHA, DNS-MT, QCP-MT: The short answer is yes, this …
- Q&A: It appears that there were multiple QSO memos that were revised or expired. What does that mean?Question: It appears that there were multiple QSO memos that were revised or expired. What does that mean? Answer from Denise Winzeler, RN, BSN, LNHA, DNS-MT, QCP-MT: Yes, CMS did some housekeeping recently and either …
- Q&A: Five days after a fall, a resident had an x-ray completed showing a fracture of the second cervical vertebra. Would the fall injury be considered a major injury due to these findings?Question: A resident fell in the facility and hit the back of her head. She was evaluated in the emergency room and had a CAT scan completed the same day, but showed no injuries. Five …
- Q&A: The RAI User’s Manual states that respiratory therapy must be performed by a “respiratory therapist” or a “respiratory nurse.” What is a “respiratory nurse”?Question: The RAI User’s Manual states that respiratory therapy must be performed by a “respiratory therapist” or a “respiratory nurse.” What is a “respiratory nurse”? Answer from Jeff Taylor:Appendix A of the RAI User’s Manual provides …
- Q&A: If an interim payment assessment (IPA) is determined to have a new primary diagnosis, does therapy need to re-evaluate the resident or can they continue treatment based on the 5-Day diagnosis?Question: If an interim payment assessment (IPA) is determined to have a new primary diagnosis, does therapy need to re-evaluate the resident or can they continue treatment based on the 5-Day diagnosis? Answer from Carol …
- Q&A: Can an LVN who is a certified treatment nurse stage a pressure injury?Question: Can an LVN who is a certified treatment nurse stage a pressure injury? Answer from Denise Winzeler, BSN, RN, DNS-MT, QCP-MT: Many states do not allow LVNs to stage pressure injuries. I recommend you review your …
- Q&A: Can I cover a resident under Medicare Part A who is receiving hospice care at the same time, or does the resident need to disenroll from hospice first?Question: Can I cover a resident under Medicare Part A who is receiving hospice care at the same time, or does the resident need to disenroll from hospice first? Answer from Carol Maher, RN-BC, RAC-MTA, …
- Q&A: What is required if a resident passes away the day after the ARD for a Significant Change in Status Assessment (SCSA) due to hospice initiation?Question: What is required if a resident passes away the day after the ARD for a Significant Change in Status Assessment (SCSA) due to hospice initiation? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, …
- Q&A: A resident on Medicare Part A admitted during the weekend. How much time do I have to open the 5-Day PPS assessment?Question: A resident on Medicare Part A admitted during the weekend. How much time do I have to open the 5-Day PPS assessment? Answer from Jeff Taylor:The 5-Day PPS assessment must be opened before the …
- Q&A: Can I still register for the AAPACN 2023 Conference?Question: Can I still register for the AAPACN 2023 Conference? Answer from AAPACN: Absolutely! Registration is open and available on the AAPACN conference webpage until April 10, 2023. This page also includes information regarding the …
- Q&A: How does the new CMS memo, QSO-23-05-NH, for the schizophrenia diagnosis apply to OBRA assessments for residents who have been in the facility long-term?Question: How does the new CMS memo, QSO-23-05-NH, for the schizophrenia diagnosis apply to OBRA assessments for residents who have been in the facility long-term? Answer from Jeff Taylor: I would say that memo, the …
- Q&A: When a resident is admitted with a diagnosis of UTI from the hospital, and has physician documentation and a lab from the hospital in the medical record, do we code UTI at I2300 on the MDS?Question: When a resident is admitted with a diagnosis of UTI from the hospital, and has physician documentation and a lab from the hospital in the medical record, do we code UTI at I2300 on …
- Q&A: If the dietitian documents a resident is at risk of malnutrition, can I code this diagnosis on the MDS at item I5600? Question: If the dietitian documents a resident is at risk of malnutrition, can I code this diagnosis on the MDS at item I5600? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: I would …
- Q&A: Would padded upper bedrails that are raised for a resident who experiences seizures be coded as a restraint?Question:Would padded upper bedrails that are raised for a resident who experiences seizures be coded as a restraint? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC:You must assess the effect the padded rails …
- Q&A: Therapy is discharging a Medicare Part A resident, but he will continue to be skilled for daily nursing services. Do I need to complete any MDS assessments to reflect this change?Question:Therapy is discharging a Medicare Part A resident, but he will continue to be skilled for daily nursing services. Do I need to complete any MDS assessments to reflect this change? Answer from Janine Cortesa, …
- Q&A: Which role should the MDS coordinator request to be able to submit assessments when signing up for the new iQIES?Question:Which role should the MDS coordinator request to be able to submit assessments when signing up for the new iQIES? Answer from Sandy Baker, RN, RAC-CT, RAC-CTA: Looking at page 11 of the “Provider User …
- Q&A: I am struggling with the MDS and Medicare Process Essentials course for the DNS-CT. Does anyone have any pointers on what more I can study to make this test easier for me? Question: I am struggling with the MDS and Medicare Process Essentials course for the DNS-CT. Does anyone have any pointers on what more I can study to make this test easier for me? Answer from …
- Q&A: Do we need to obtain an order from a physician to be able to place a new admission or move a current resident to the secured (locked) unit in our care facility?Question: Do we need to obtain an order from a physician to be able to place a new admission or move a current resident to the secured (locked) unit in our care facility? Answer from …
- 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: 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 …