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 IV chemotherapy be excluded from consolidated billing during a Part A stay?Question: Can IV chemotherapy be excluded from consolidated billing during a Part A stay? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC: Exclusion for chemotherapy is based on the Healthcare Common Procedure Coding System (HCPCS) …
- Q&A: What costs should be included when explaining a SNF ABN to a resident?Question: I have always thought that delivery of the SNF ABN (CMS – 10055) notice offers the Medicare recipient the opportunity to pay for the Medicare Part A services being cut. I was told the …
- Q&A: If a resident revokes hospice services, does the ARD need to be scheduled to avoid coding hospice in O0110K?Question: If a resident revokes hospice services, does the ARD need to be scheduled to avoid coding hospice in O0110K? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The Significant Change in Status Assessment …
- Q&A: When must resident interviews be completed for the MDS?Question: Please clarify when resident interviews need to be completed for the MDS? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: All resident interviews, including the Customary Routine/Activities, BIMS, PHQ-2 to 9, …
- Q&A: Do I need to complete discharge assessments for an emergency evacuation?Question: Do I need to complete discharge assessments for an emergency evacuation? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You may not be required to complete the discharge MDS in this situation. Here …
- Q&A: What are the correct dates for flu season and pneumonia vaccines for MDS purposes to count if present during that time?Question: What are the correct dates for flu season and pneumonia vaccines for MDS purposes to count if present during that time? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: The influenza vaccine question …
- Q&A: Does every CAA trigger require a care plan intervention?Question: I need clarification regarding the CAA notes: I was understanding that anything that triggers we would address in the care plan. Do we have to address every single CAA note even if it does …
- Q&A: How do I support MDS coding of a medication in N0415 when a surveyor disagrees with the classification?Question: During our annual survey, I was questioned about coding methenamine as an antibiotic on the MDS. I had coded it based on information received from AAPACN and references discussed in this forum. The surveyor …
- Q&A: Is a signed diagnosis list enough to support coding in section I?Question: Is a signed diagnosis list enough to support coding diagnoses in section I, or does the physician need to document the diagnosis as active in their notes? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, …
- Q&A: If a resident returns on day 30 after discharge (return anticipated), is it a readmission or new admission?Question: If a resident was discharged return anticipated and comes back on day 30, would this be considered a readmission or a new admission? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the …
- Q&A: When resuming Medicare Part A within the 30-day transfer rule, which GG observation period should be used on a Significant Change in Status (SCSA) combined with a 5-Day?Question: When resuming Medicare Part A within the 30-day transfer rule, which GG observation period should be used on a Significant Change in Status (SCSA) combined with a 5-Day? Answer from Jennifer LaBay, RN, RAC-MT, …
- Q&A: Does “at risk for malnutrition” qualify for coding if it is only documented by a dietitian and not by a physician?Question: Does “at risk for malnutrition” qualify for coding if it is only documented by a dietitian and not by a physician? Answer from Jeff Taylor: The steps for assessment and coding instructions for I5600 …
- Q&A: Can Medicare Part A continue for a new pressure ulcer not related to the hospital stay?Question: A resident admitted after hospitalization is completing therapy but developed an unstageable pressure ulcer during the SNF stay. Can Medicare Part A continue for skilled nursing, even though the condition was not part of …
- Q&A: What should be done with an incomplete MDS if a resident passes away?Question: If a resident dies before an assessment is completed, should the MDS be finished or canceled? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: When a resident dies while in the middle of …
- Q&A: Does one new pressure ulcer require a Significant Change in Status Assessment?Question: If a resident develops a blood blister or pressure ulcer but has no other decline in ADLs, cognition, or condition, is a Significant Change in Status Assessment (SCSA) required? Answer from Carol Maher, RN, …
- Q&A: Should Z99.2, Dependence on renal dialysis, be coded when dialysis occurs outside the facility?Question: A dialysis patient is going out of the facility for dialysis. We use the appropriate N18 code, but would Z99.2 be excluded since dialysis isn’t provided in-house? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, …
- Q&A: Is an SCSA required if hospice is revoked and resumed quickly?Question: We have a patient who is on hospice but elected to be sent out over the weekend for an acute illness, so he revoked his hospice status. He came back less than 24 hours …
- Q&A: Is a hairline fracture from a fall considered a major injury?Question: If a resident has a fall that causes a hairline clavicle fracture, is that automatically considered a major injury? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC:Yes, any traumatic fracture related to a …
- Q&A: If a resident’s last Medicare Part A covered day is the day before the physical discharge from the facility, can the PPS Discharge and OBRA Discharge assessments be combined?Question: A resident’s last therapy day was on 3/5. He didn’t go home until the afternoon of the next day, 3/6. Can I combine the OBRA Discharge and the PPS Discharge assessments, or since the …
- Q&A: A resident’s wheelchair tipped backward in therapy. The physical therapy assistant was able to catch him, but it resulted in a skin tear to the arm. The resident remained in the wheelchair and did not come to rest on the ground. Should this be coded as a fall?Question: A resident’s wheelchair tipped backward in therapy. The physical therapy assistant was able to catch him, but it resulted in a skin tear to the arm. The resident remained in the wheelchair and did …
- Q&A: A resident on a Medicare Part A stay was sent to the emergency department by ambulance at 6:45 p.m. on Feb. 2 and returned to the facility just after midnight without being admitted to the hospital. Would this situation qualify as an interrupted stay?Question: A resident on a Medicare Part A stay was sent to the emergency department by ambulance at 6:45 p.m. on Feb. 2 and returned to the facility just after midnight without being admitted to …
- Q&A: If the registered dietitian documents a resident is at risk for malnutrition within the MDS look-back period, can “risk for malnutrition” be coded on the MDS section I5600?Question: If the registered dietitian documents a resident is at risk for malnutrition within the MDS look-back period, can “risk for malnutrition” be coded on the MDS section I5600? Answer from Jennifer LaBay RN, RAC-MT, …
- Q&A: How do you code discharge status, A2105, when the resident discharged to a hotel?Question: How do you code discharge status, A2105, when the resident discharged to a hotel? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: A discharge to a homeless shelter, jail, or hotel would be …
- Q&A: If a resident has a diagnosis of “schizoaffective disorder, bipolar type,” how is this coded on the MDS?Question: If a resident has a diagnosis of “schizoaffective disorder, bipolar type,” how is this coded on the MDS? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Schizoaffective disorder would be coded at I6000, …
- Q&A: Can you please clarify “head injury”—the criteria for coding major injury at J1900C?Question: Can you please clarify “head injury”—the criteria for coding major injury at J1900C? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA: CMS did not provide a definition of major injury but instead provided a …
- Q&A: When coding height for a resident with bilateral lower leg amputations, do you code the height prior to amputation or after?Question: When coding height for a resident with bilateral lower leg amputations, do you code the height prior to amputation or after? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You code the height …
- Q&A: If a long-stay resident has a Stage 2 pressure ulcer and it heals, would a Significant Change in Status Assessment (SCSA) be required?Question: If a long-stay resident has a Stage 2 pressure ulcer and it heals, would a Significant Change in Status Assessment (SCSA) be required? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: On page …
- Q&A: Am I able to code “yes” in item J1400, Prognosis, when the documentation supporting “life expectancy less than six months” is signed by nurse practitioners or physician assistants, or is a physician signature required?Question: Am I able to code “yes” in item J1400, Prognosis, when the documentation supporting “life expectancy less than six months” is signed by nurse practitioners or physician assistants, or is a physician signature required? …
- Q&A: Can I set a 5-Day PPS assessment on a non-billable day such as a skip day? The resident was sent to the hospital, did not return prior to midnight, and was not admitted.Question: Can I set a 5-Day PPS assessment on a non-billable day such as a skip day? The resident was sent to the hospital, did not return prior to midnight, and was not admitted. Answer …
- Q&A: What specialized training is needed to capture respiratory therapy provided by nurses? Question: What specialized training is needed to capture respiratory therapy provided by nurses? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC:The Glossary of the RAI User’s Manual (Appendix A-22) states this: Respiratory Therapy …
- Q&A: The SNF QRP Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted?Question: The Skilled Nursing Facility Quality Reporting Program (SNF QRP) Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: On the …
- Q&A: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS? Question: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete? Question: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete? Answer from Jennifer LaBay RN, …
- Q&A: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer?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 …
- Q&A: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period?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 …
- Q&A: 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?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 …
- Q&A: 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? 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 …
- Q&A: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet?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 …
- Q&A: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day?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: …
- Q&A: 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?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 …
- Q&A: 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?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 …
- Q&A: Can we still use dementia as a primary diagnosis for our long-term residents?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 …
- Q&A: 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?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 …
- Q&A: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K?Question: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You use the weight that is closest …
- Q&A: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight? Question: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight? Answer from Jeff Taylor: The actual time/date …
- Q&A: Can the physician certification be met through a detailed order versus a separate certification form?Question: Can the physician certification be met through a detailed order versus a separate certification form? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: CMS does not mandate a specific form or format, but …
- Q&A: We have a resident that had a qualifying hospital stay (QHS), then went to an LTACH for more than 30 days. Can the resident utilize their Medicare benefits since the transfer from acute hospital to SNF is more than 30 days?Question: We have a resident that had a qualifying hospital stay (QHS), then went to a long-term acute care hospital (LTACH) for more than 30 days. Can the resident still utilize their Medicare benefits in …
- Q&A: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay?Question: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, …
- Q&A: Is there a specific table that shows which items if dashed will count against us for the Skilled Nursing Facility Quality Reporting Program (SNF QRP)?Question: Is there a specific table that shows which items if dashed will count against us for the Skilled Nursing Facility Quality Reporting Program (SNF QRP)? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: …
- Q&A: Is a Pure Wick catheter coded as an external catheter? Question: Is a Pure Wick catheter coded as an external catheter? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Yes, this would meet the definition of an external catheter in the …
- Q&A: When assessing a fall with an injury to the head, such as a laceration, bruise, or hematoma, would this automatically be considered a major injury? Question: When assessing a fall with an injury to the head, such as a laceration, bruise, or hematoma, would this automatically be considered a major injury? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA and …
- Q&A: How do you code walking if the resident only walks with therapy staff?Question: How do you code walking if the resident only walks with therapy staff? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, RN, BSN, RAC-MTA, RAC-CTA: If the resident only walked …
- Q&A: With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury? With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury?Question: With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury? With the new definition of fall with major injury, would a bump …
- Q&A: I am confused by the new section GG guidance for when the activity “is being/will be” routinely performed. What does “will” mean?Question: I am confused by the new section GG guidance for when the activity “is being/will be” routinely performed. What does “will” mean? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, …
- Q&A: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount of time. What are all the required MDS assessments that need to be completed on this resident? I know an entry tracker and an OBRA discharge, but do we need to also complete a 5-Day PPS?Question: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount …
- Q&A: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus car accidents or impact of another person or object against the resident.” Does this instruction contradict the new definition of a fall?Question: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus …
- Q&A: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound?Question: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: No, the RAI User’s Manual specifically states that isolation cannot be coded for …
- Q&A: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.”Question: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.” Answer from …
- Q&A: A long-term resident went out to the hospital and returned on a skilled stay using his Managed Care plan. He has both a 5-Day and Annual scheduled for the same day, but at separate times. Do both of these get coded as “the first assessment” in A0310E?Question: A long-term resident went out to the hospital and returned on a skilled stay using his Managed Care plan. He has both a 5-Day and Annual scheduled for the same day, but at separate …
- Q&A: For section GG, the nurse aides use a mechanical lift transfer with two-person assist for transfers four times, but physical therapy transfers with one person and maximal assist once. Part of the dependent definition is “helper does all the effort” – but this was not true for all transfers—would this be dependent or maximal assistance?Question: For section GG, the nurse aides use a mechanical lift transfer with two-person assist for transfers four times, but physical therapy transfers with one person and maximal assist once. Part of the dependent definition …
- Q&A: Can I count IV fluids and IV antibiotics that were administered in the hospital before admission and within the 7-day look-back period?Question: Can I count IV fluids and IV antibiotics that were administered in the hospital before admission and within the 7-day look-back period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: IV fluid provided …
- Q&A: I miscalculated the ARD window for a 5-Day and scheduled the 5-Day/PPS Discharge on day 9 of the Medicare stay. What do I need to do?Question: I miscalculated the ARD window for a 5-Day and scheduled the 5-Day/PPS Discharge on day 9 of the Medicare stay. What do I need to do? Answer from Jeff Taylor:Leave everything as it is …
- Q&A: Does the 14-day look-back period for section O include days prior to entry into the facility?Question: Please clarify if section O “while a resident.” Per the RAI User’s Manual, “Check all treatments, procedures, and programs that the resident received or performed after admission/entry or reentry to the facility and within …
- Q&A: When should I set an assessment reference date (ARD) for a Significant Change in Status Assessment (SCSA) after a resident elected hospice?Question: When should I set an assessment reference date (ARD) for a Significant Change in Status Assessment (SCSA) after a resident elected hospice? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The …
- Q&A: I know that McGeer criteria must be met when coding a UTI that develops in-house during the SNF stay, but what is required when a resident is transferred to the hospital and returns to the SNF with a documented UTI diagnosis (e.g., listed on the discharge summary and on antibiotics)?Question: I know that McGeer criteria must be met when coding a UTI that develops in-house during the SNF stay, but what is required when a resident is transferred to the hospital and returns to …
- Q&A: The Five-Star Preview Report for July 2025 still shows the standard survey from three years ago. I thought the third survey would no longer be used?Question: The Five-Star Preview Report for July 2025 still shows the standard survey from three years ago. I thought the third survey would no longer be used? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: A resident elected hospice on July 9, 2025. What is the required completion date for the Significant Change in Status Assessment (SCSA), and what steps should be taken if the resident passes away before the assessment is completed?Question: A resident elected hospice on July 9, 2025. What is the required completion date for the Significant Change in Status Assessment (SCSA), and what steps should be taken if the resident passes away before …
- Q&A: Is aspirin coded as an antiplatelet in N0415I?Question: Is aspirin coded as an antiplatelet in N0415I? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The RAI User’s Manual includes aspirin as an antiplatelet medication on page N-9: “N0415I1. Antiplatelet: Check if …
- Q&A: How do we code interviews that were not complete when a Medicare resident has an unplanned discharge to the hospital?Question: How do we code interviews that were not complete when a Medicare resident has an unplanned discharge to the hospital? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the interviews were not …
- Q&A: If a resident initiates his/her discharge for the following day and the facility was able to organize home care, equipment, etc., is this considered a planned or unplanned discharge?Question: If a resident initiates his/her discharge for the following day and the facility was able to organize home care, equipment, etc., is this considered a planned or unplanned discharge? Answer from Jessie McGill RN, …
- Q&A: Did this resident achieve a 60-day break in skilled services when a nurse assisted with tube feedings at the assisted living facility?Question: A resident previously exhausted his 100 days of Medicare for a new feeding tube. He was discharged to an assisted living facility (ALF) for more than 60 days where an licensed practical nurse (LPN) …
- Q&A: The RAI User’s Manual guidance for mechanically altered diet mentions “soft solids.” Would that include solids that are naturally soft or solids that we would “soften”?Question: The RAI User’s Manual guidance for mechanically altered diet mentions “soft solids.” Would that include solids that are naturally soft or solids that we would “soften”? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: If the resident was in the emergency department (ED) and then admitted to the hospital before readmitting to the nursing home, can I capture IV fluids at the ED visit? Question: If the resident was in the emergency department (ED) and then admitted to the hospital before readmitting to the nursing home, can I capture IV fluids at the ED visit? Answer from Jessie …
- Q&A: Can Z codes be used as the admitting diagnosis on the claim?Question: Can Z codes be used as the admitting diagnosis on the claim? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: Admission Diagnosis codes (Field Locator 69 on the claim) should be the code …
- Q&A: A long-term care resident has a Quarterly assessment due on 6/19 and an Annual assessment due on 6/27. Can I do the Annual assessment early, before the Quarterly deadline?Question: A long-term care resident has a Quarterly assessment due on 6/19 and an Annual assessment due on 6/27. Can I do the Annual assessment early, before the Quarterly deadline? Answer from Carol Maher, RN, …
- Q&A: A resident came to our facility for a short stay with a Stage 4 pressure ulcer. The resident has since exhausted his 100 days of Medicare, became a long-term resident, and still has the Stage 4 pressure ulcer. Will this resident trigger the long-stay pressure ulcer measure?Question: A resident came to our facility for a short stay with a Stage 4 pressure ulcer. The resident has since exhausted his 100 days of Medicare, became a long-term resident, and still has the …
- Q&A: When a resident received IV fluids (K0520A) for hydration, but did not have any calories from the fluids, do we code K0710A (Proportion of total calories the resident received through parenteral or tube feeding) as 1. 25% or less?Question: When a resident received IV fluids (K0520A) for hydration, but did not have any calories from the fluids, do we code K0710A (Proportion of total calories the resident received through parenteral or tube feeding) …
- Q&A: A resident was admitted to our facility on Medicare Part A and passed in facility after only a couple of hours. I had scheduled a 5-Day/Admission for the 7th day before she passed. How do I set up MDS assessments?Question: A resident was admitted to our facility on Medicare Part A and passed in facility after only a couple of hours. I had scheduled a 5-Day/Admission for the 7th day before she passed. How …
- 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: 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: 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 …
- Q&A: What are the changes affecting SNFs in the updated blanket waiver that was recently released?The COVID-19 Emergency Blanket Waivers for Health Care Providers that was updated and released on Nov 29, 2021 adds a new waiver that allows more flexibility in the education and training requirements for individuals serving …
- Q&A: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment?Question: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment? Answer by Carol Maher, RN-BC, CPC, RAC-MT : A restraint …
- Q&A: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services?Question: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services? Answer by Kim Steele RN, WCC, RAC-CT, RAC-CTA: There is no …
- Q&A: Where can I find the CMS Quality Safety and Oversight (QSO) memos?Question: Where can I find the CMS Quality Safety and Oversight (QSO) memos? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT AAPACN Curriculum Development Specialist: QSO memos issued from CMS can be found on …
- Q&A: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer?Question: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer? Answer from Janine Cortesa RN, BSN: A stage 3 pressure ulcer may signify the need for a Significant Change …
- Q&A: When a Medicare Part A resident discharges to another SNF and will continue skilled Medicare there, what assessments are required and what is the date used in A2400C?Question: I have a Medicare Part A resident discharging to another SNF and will continue skilled Medicare there. Would I combine the OBRA Discharge with a PPS Part A Discharge assessment? In A2400, would I …
- Q&A: Where can I find information on the new CMS COVID-19 vaccination requirements?Question: Where can I find information on the new CMS COVID-19 vaccination requirements? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: CMS has developed a FAQ document regarding the Interim Final Rule that answers …
- Q&A: A resident discharged to the hospital, return anticipated, but went to a sister facility from the hospital for a few days because we did not have a bed available. Now that he is returning, is a new OBRA Admission assessment required?Question: We have a resident who discharged to the hospital (completed an OBRA DC Return-Anticipated). When he was ready to be discharged from the hospital, we did not have a bed available, so he discharged …
- Q&A: Where can I find resources to help our facility prevent and manage sepsis?Question: Where can I find resources to help our facility prevent and manage sepsis? Answer: TMF, a Quality Improvement Organization, offers a free toolkit called the Sepsis Post-Acute Care Training Toolkit for Nursing Homes. This …
- Q&A: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I?Question: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I? Answer from Heide Keen, RN, BSN, RAC-CT: Most often, we find that MRSA of nares is colonized …
- Q&A: Is there specific guidance regarding staff working in multiple facilities?Question: Is there specific guidance regarding staff working in multiple facilities? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: Currently, there are no federal guidelines specific to staff who work in multiple facilities. However, …
- Q&A: How do you determine “while a resident” or “while not a resident” when a resident goes out to the hospital and returns?Question: How do you determine “while a resident” or “while not a resident” when a resident goes out to the hospital and returns? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The …
- Q&A: Can a resident disenroll in a Medicare Advantage (MA) plan and revert back to Original Medicare when the 3-day qualifying hospital stay was waived for the MA plan?Question: A resident admitted for skilled care under a Medicare Advantage (MA) plan. The plan did not require a 3-day qualifying hospital stay (QHS) and the resident was hospitalized for observation only. The resident has …
- Q&A: What will happen to the online AADNS communities, discussion groups, and libraries?Question: What will happen to the online AADNS communities, discussion groups, and libraries? Answer from AAPACN: The AADNS Network has become a new member community named the Management/Leadership General Discussion community on AAPACN.org. The discussion …
- Q&A: Will I still be able to access AADNS courses that I am currently taking on the new AAPACN website?Question: Will I still be able to access AADNS courses that I am currently taking on the new AAPACN website? Answer from AAPACN: Yes. You still have access to any courses that have not expired …
- Q&A: Is overseeing the Therapy department within the scope of the DNS position?Question: I am a relatively new DNS and my job description includes overseeing the Therapy Department. Is this within my scope? Answer: In most SNFs, the therapy department usually has its own director/manager, with ultimate oversight …