Coding of activities of daily living (ADLs) on the MDS is complex and often misunderstood by those engaged in completing the assessment. In addition to affecting care, public information and survey, this area of the MDS has a tremendous financial impact. During this session, the speaker will define the late loss ADLs and provide insights aimed at helping facility staff document resident status accurately. Calculating the ADL score for the RUG-IV system will be reviewed and implications of inappropriate coding will be demonstrated. Using dollar-impact case studies, the attendee will learn why this section is critical for the facility’s financial success.
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Documenting the Long-term Care You Provide
1. Documenting the Care You Provide:
ADL Accuracy
HARMONY UNIVERSITY
The Provider Unit of
Harmony Healthcare International, Inc.
(HHI)
Presented by:
Christine Twombly, RNC, RAC-MT, LHRM
Regional Consultant / Trainer
The second bullet on this slide is a key point and something that differs from the MDS 2.0 – on the 2.0, theoretically, a facility could take credit for hurrying up and doing an activity for a resident that in fact he or she could do – this is not the case with the MDS 3.0. The resident must be unable or unwilling to participate.
There are a couple of other potential codes – to use when the activity does not happen at least three times – we will review those on the next couple slides.
The four late loss ADLs are defined here – it is critical that documentation support coding on these ADLs are these are the four that are tied to reimbursement. As the name suggests, they are the last that a person looses the ability to participate in and they are most predictive of resource use.
Spend a few minutes talking to your neighbors
As a group, determine what are the subtasks of the following ADLs:
Bed Mobility – turn side to side, pull up, sit to lay day and vice versa
Personal Hygiene – washing up, shaving, teeth, hair, make up
Dressing – dressing, undressing, teds, prosthetic application
Bed Mobility—handing the resident the bar on a trapeze, staff raises the ½ rails for the resident’s use and then provides no further help.
— Transfer—giving the resident a transfer board or locking the wheels on a wheelchair for safe transfer.
— Locomotion
o Walking—handing the resident a walker or cane.
o Wheeling—unlocking the brakes on the wheelchair or adjusting foot pedals to facilitate foot motion while wheeling.
— Dressing—retrieving clothes from the closet and laying out on the resident’s bed; handing the resident a shirt.
— Eating—cutting meat and opening containers at meals; giving one food item at a time.
— Toilet Use—handing the resident a bedpan or placing articles necessary for changing an ostomy appliance within reach.
— Personal Hygiene—providing a washbasin and grooming articles.
Let’s take a few minutes and practice coding these examples of the four late loss ADLs:
Coding: G0110A1 would be coded 4, total dependence G0110A2 would be coded 3, two+ persons physical assist
Rationale: Resident did not participate at any time during the 7-day look-back period and required two staff to position her in bed.
Coding: G0110B1 would be coded 1, supervision G0110B2 would be coded 1, setup help only
Rationale: Resident requires staff supervision, cueing, and reminders for safe transfer. This activity happened daily over the 7-day look-back period.
Coding: G0110H1 would be coded 3, extensive assistance G0110H2 would be coded 2, one person physical assist
Rationale: Resident partially participated in the task daily at each meal, but one staff member provided weight-bearing assistance with some portion of each meal.
Coding: G0110I1 would be coded 3, extensive assistance G0110I2 would be coded 2, one person physical assist
Rationale: During the 7-day look-back period, the resident required weight-bearing assistance to use the commode four times.
What about if this resident got up once during the middle of the night and needed two person assist to transfer to the bedside commode – would that change your coding???
3,2 =2
3,2 =2
0,1 =0
2,2 =1
Total score = 5
Talk about RU implication