MDS Corner with Judy Bagby, BSN

In this week's episode of MDS Corner with Judy Bagby, BSN: Section G- Coding ADLs

  October 1, 2013 CMS posted clarification on MDS key coding items.  This week we’ll discuss how to code ADLs for section G0110.   The information being keyed in this section influences the RUG level for PPS, Managed Care, Case Mix rates and PEPPER Reports.  In the review process by payment sources this item set affects reimbursement recoupments.

   The clarification from CMS pertains to the use of the ADL Self Performance Alogrithm found on page G-6 of the RAI Manual.  The clarification that was posted did not change how the resident ADLs were to be scored, but was a reminder of the “Rule of 3” that has been in place since the initial use of MDS 3.0.  On the MDS the look back period is 7 days.  Self -Performance measures what the resident actually did with each ADL for G0110.  The ADL question identifies the most support that staff provided over the 7 day observation period.  The staff should provide information each shift over the 7 day observation period to support the coding on the MDS and identify inconsistencies with resident needs.

   What is the Rule of 3?  This is when an ADL Self Performance activity occurs 3 or more times at any one given level.  The coder keys that level for self- performance.   But what happens when the activity occurs at more than one level?  This requires assessment to rule out incorrect staff reporting and also to identify unexplained variations in reporting resident abilities, or staff “not letting the resident perform when able.”  With the Rule of 3 “if an activity occurs 3 times at multiple levels the coder uses the most dependent area.  Exceptions are total dependence (4)-activity must require full assistance every time; and activity did not occur (8)- activity must not have occurred at all.  Example: three times extensive assist (3) and three times limited assist (2)- code extensive assist (3).”  When an activity occurs at “more than one level but not three times at any one level” follow the ADL Self Performance Alogrithm and remember if none of the Rule of 3 conditions are met you code as Supervision.   Getting staff in- put multiple times on all shifts during the 7 day observation will help to ensure correct coding,

  The RACs, MACs, Managed Care and now PEPPER are focused on the importance of the RUG level being determined by how ADL Self Performance was coded on an MDS.  Education of staff must be ongoing for accuracy in this area as it relates to payment and a cross reference to resident performance with resource needs.  The goal continues to be focused on services being provided to assist the resident with maintaining their highest level of functioning.