The MDS Mentor September 2008 - Texas Department of Aging and
Contents
1. STATE OF TEXAS he MDS Mentor is published in March June September and December each year If you have an article an idea for an article or would like to give us feed back please see page 4 for our contact information INSIDE THIS ISSUE Section MI l Section MI 2 Section M2 2 Section M3 2 Automation 3 News Coming 4 Soon Contact Us 5 Websites The MDS Mentor Cheryl Shiller BSN RN RAC CT MDS Clinical Coordinator VOLUME I ISSUE 3 Section MI Ulcers Many facility staff have called to tell me that trying to figure out how to code ulcers in Section MI on the Minimum Data Set MDS gives them ulcers of an entirely different variety Therefore in an effort to improve resident assessments and employee health let s review how to appropriately code Sec tion MI First the Resident Assessment Instrument RAI User s Manual v 2 0 Dec 2002 page 3 159 states that the intent of Section MI is to record the number of skin ulcers at each ulcer stage on any part of the body This includes the feet Although Section M6 specifically addresses foot problems the feet are still part of the body and ulcers on the feet are included in MI Second although the MDS form requires coding ulcers due to any cause the RAI Manual indicates that skin ulcers that develop because of circulatory problems or pressure are coded in item MI The RAI Manual and not the for2. is to code the highest stage for two types of skin ulcers pressure and stasis present in the last 7 days Some examples of staging pressure and stasis ulcers follow Section M3 has one of the longest look back periods on the MDS 90 days The intent is to code if the resi dent has a history of skin ulcers that have healed re solved or been cured in the last 90 days Remember that the reference to skin ulcers contained in Section M3 uses the same definitions of skin ulcers used in Section MI so it includes pressure arterial and venous ulcers If the resident has no history of resolved skin ulcers Code 0 zero for No If the resident has a history of and not as a skin ulcer If the graft fails continue to code it as a surgical wound until healed To fill in Section MI items a Stage I b Stage 2 c Stage 3 and d Stage 4 on the MDS simply count the number of ulcers corresponding to each stage on the resident s body and then fill in the number on the form in the appropriate block If there are no skin ulcers for a particular stage then record a 0 zero in the ap propriate box The limitation is if there are more than 9 skin ulcers at any one stage enter a 9 nine in the appropriate box The system is not designed to accept a number greater than 9 for ulcers at any one stage Source RAI User s Manual pages 3 159 amp 3 160 e Item M2a Pressure Ulcer if the highest stage of a pressure
3. 0 RAVEN and AT amp T Client Soft ware information Validation Report Messages Guides Training and DAVE DAVE 2 Tip sheets https www qtso com Quality Reporting System QRS DADS information site on Texas nursing homes http facilityquality dads state tx us Nursing Home Compare CMS site that compares nursing homes in a given area http www medicare gov NHCompare Include DataSection Questions SearchCriteria asp The MDS Mentor http qmweb dads state tx us mdsweb Sign up for E mail Updates Go to http www dads state tx us
4. cili ties certainly may adopt the National Pressure UI cer Advisory Panel NPUAP standards in their clinical practice However the NPUAP standards cannot be used for coding on the MDS Continued on page 2 VOLUME I ISSUE 3 PAGE 2 Section MI Staging amp Counting Ulcers Continued from page If necrotic eschar is present which prohibits accurate staging of the ulcer then code the skin ulcer as a Stage 4 until the eschar has been debrided to allow staging the RAI page 3 160 Debridement of an ulcer merely removes necrotic and According to Manual decayed tissue to promote healing The skin ulcer still exists and may or may not be at the same stage as it was prior to debridement Good clinical practice dic tates that the ulcer be re examined and re staged after debridement Do not code the debrided skin ulcer as a surgical wound However the RAI Manual continues with different instructions If a skin ulcer is repaired with a flap graft it should be coded as a surgical wound L E E E A ee ee ee ee ee ee Section M2 Type of Ulcer Sometimes facility staff report that they are not sure of the cause or the type of an ulcer It is important that facility staff involve the resident s physician and other health team professionals to determine the cause type and staging of all ulcers to ensure accurate MDS coding The RAI Manual instructions for Section M2 page 3 161 state the intent
5. es information concerning HIPPS codes It is the responsibility of the individuals who com plete the MDS to have the most current RAI manual instructions in order to accurately complete the re quired assessments The revision table and replacement pages are available at CMS MDS Manuals and Forms a LTCMI form to the TMHP Online Portal Review the TILES to RUGS web site for more on the LTCMI form information letters ILs rules and training It is highly recommended that you configure your MDS software to calculate the Medicaid RUG score This will eliminate Warning Messages 306 and 307 unless the software incorrectly calculates the RUG Review Texas Medicaid CMI Set amp Raven Instruc tions IL 08 41 and IL 08 54 on the T2R website for instruction on setting up your software Call Cecile by phone at 512 438 2396 if you need help RUG Training Offered Nurses who complete the LTCMI form are required to take the computer based RUG Training prior to submitting the LTCMI form NPI Number The facility s National Pro vider Identifier NPI number must be en tered into MDS item WI The NPI number Is used to pull assessments into the TMHP por tal If you modify an assessment to add the missing NPI number then it will appear in the and assessment TMHP portal 7 PAGE 3 Extending our hands in care Coming Soon You asked and we answered We are going to put frequently asked questions in writin
6. ew Medicaid reimbursement methodology The fed eral Resource Utilization Group RUG determined by completion of the Minimum Data Set MDS replaced the Texas Index for Level of Effort TILE A new form the Long Term Care Medicaid Information LTCMI form replaced MDS Section S and CARE form 3652A After a MDS assessment is submitted to the state database for a Medicaid nursing home resident with one of the following reasons for assessment AA8a 01 02 03 04 05 or 10 the MDS coordinator submits The News in Review Section S Discontinued Effective September 2008 facilities no longer need to complete MDS Sec tion S Assessments submitted after September 2008 that have Section S completed will be accepted with out generating a warning message Your software ven dor can help you eliminate Section S Section U Facilities are not required to complete Section U the Medication portion of the MDS The data is not stored in the state database but facility management may require completion of Section U for facility purposes 2 Outlines factors affecting SNF assessment schedules coding and late assessments 3 Gives guidance on when to select Total Dependence vs Activity Did Not Occur for coding Eating in GIhA 4 Adds definition of back dating and clarifies which date to use when signing R2b 5 Revises guidance for when the flu season begins based on the vaccine being available to the public 6 Clarifi
7. g so everyone can see the answers We are calling it MDS Questions Asked and Answered Check the following websites for MDS Questions Asked and Answered Texas Minimum Data Set Juality Monitoring Program Resource Send your questions to us at Cheryl Shifter BSN RN RAC CT Cecile Hay LMSW rar m E E E ele ee Eel Cheryl Shiffer BSN RN RAC CT MDS Clinical Coordinator 1307 Roszell Street Room 1910 San Antonio TX 78217 Mail Code 279 4 Phone 210 619 8010 Fax 210 619 8159 Shared Fax Call First Cecile Hay LMSW MDS Automation Coordinator P O Box 149030 Austin TX 78714 9030 Mail Code E 345 Phone 512 438 2396 Fax 512 438 4286 Shared Fax Call First E Mail cheryl shiffer dads state tx us E Mail cecile hay dads state tx us Useful Web Links Help is Justa Click Away Centers for Medicare amp Medicaid Services CMS MDS Web Site MDS 2 0 Highlights MDS RAI Manual with updates and a link to MDS 3 0 http www cms hhs gov NursingHomeQualitylnits 20 NHOIMDS20 as CMS MDS Training Web Site MDS computer based training CBT http www mdstraining org upfront ul asp Quality Matters MDS Web Site News and clinical assistance for MDS coordinators http mqa dads state tx us MDSweb DADS MDS Web Site Texas MDS Policy page http www dads state tx us providers MDS index cfm QIES TECHNICAL SUPPORT OFFICE QTSO MDS 2 0 3
8. m dictates how the MDS is filled out So included in Section MI are pressure ulcers and circulatory ulcers such as arte Ba Sn HH conse Aging and Disability Services SEPTEMBER 2008 As we move into the beauty of fall let s re member the beauty of accurate MDS coding rial ischemic ulcers and venous stasis ulcers The RAI Manual further clarifies that Rashes without open areas burns desensitized skin ulcers related to diseases such as syphilis and cancer and surgical wounds are NOT coded here but are included in Item M4 Skin tears shears are coded in Item M4 unless pressure was a contributing factor So when pressure was a factor or the tear shear develops into a pressure ulcer it must be coded in MI Section MI Staging amp Counting Ulcers Now that the types of ulcers that are included in Section MI are defined lets address staging the ulcers The look back period for Section MI is 7 days and the RAI Manual still on page 3 159 de fines the 4 Stages that must be used to stage all ulcers pressure arterial and stasis and notes For the MDS assessment staging of ulcers should be coded in terms of what is seen i e visible tissue during the look back period For example a healing Stage 3 pressure ulcer that has the appearance i e presence of granulation tissue size depth and color of a Stage 2 pressure ulcer must be coded as a 2 for purposes of the MDS assessment Fa
9. ulcer in the last 7 days was a Stage 4 then code item M2a as a 4 e tem M2b Stasis Ulcer if the highest stage of a stasis ulcer in the last 7 days was a Stage 2 then code item M2b as a 2 Remember these are not the only types of ulcers included in MI You could have various stages of ulcers coded in MI but if they are all arterial ischemic ulcers M2a and M2b would both be 0 zero 7 j resolved skin ulcers Code one for Yes One common question is How does an f ulcer s coding change as the result of a sur gical flap graft The RAI Manual instructs you to change from coding it as an ulcer in MI to coding it as a surgical wound in M4g When this happens although the ulcer did We are not limited by our old not heal or resolve the RAI Manual also age we are liberated by it W Stu Mittleman ed it instructs you to code M3 as a for Yes VOLUME I ISSUE 3 Automation News by Cecile Hay MDS Automation Coordinator Following the path to excellence in completing the MDS The Centers for Medicare and Medicaid Services CMS posted a July 2008 revision to the Long Term Care Facility Resident Assessment Instrument User s Manual Version 2 0 2008 Key changes include Clarification for completing a significant change as sessment when hospice is elected TILES to RUGS T2R Effective September 2008 Texas implemented a n
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