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Diving In Deeper: MDS 3.0 RAI User’s Manual Update

The Centers for Medicare & Medicaid Services (CMS) recently released a revised version of the MDS 3.0 Resident Assessment Instrument (RAI) User’s Manual.

Let’s take an in-depth look at the changes, which were fairly minimal, according to Diane Brown, BA, director of postacute education at HCPro, Inc. The changes (which are underlined) were mostly clarifications and include:

  1. Chapter 2
    • ADDED: If a resident goes from Medicare Advantage to Medicare Part A, the Medicare PPS schedule must start over with a 5-day PPS assessment as the resident is now beginning a Medicare Part A stay.  The 1st day of Medicare A becomes day 1 for the SNF PPS assessment.
  2. Chapter 3
    • Hyperlinks updated
    • Page 4 – There are five four date items (A2400C, M0300B3, O0400A6, O0400B6, and O0400C6) that use a dash-filled value to indicate that the event has not yet occurred. For example, if there is an ongoing Medicare stay, then the end date for that Medicare stay (A2400C) has not occurred, therefore, this item would be dash-filled.
      • Editor’s note: As seen above, even though this has been updated to four date items, CMS still lists five.
    • Should the BIMS be conducted?
      • Coding Tips: If the resident needs an interpreter, every effort should be made to have an interpreter present for the BIMS. If it is not possible for a needed interpreter to participate on the day of the interview, code C0100 = 0 to indicate interview not attempted and complete C0700-C1000, Staff Assessment of Mental Status, instead of C0200-C0500, Brief Interview for Mental Status.
      • NEW: Includes residents who use American Sign Language (ASL)
    • REVISED: M0210 Unhealed Pressure Ulcers, M-4 Planning for Care:
      • Pressure ulcer staging is an assessment system that provides a description and classification based on of anatomic depth of soft the extent of visible tissue damage. This tissue damage can be visible or palpable in the ulcer bed. Pressure ulcer staging and also informs expectations for healing times
    • NEW: M0210 Unhealed Pressure Ulcers, M-5 Coding Tips:
        • Oral Mucosal ulcers caused by pressure should not be coded in Section M.  These ulcers are captured in item L0200C, Abnormal mouth tissue. Mucosal ulcers are not staged using the skin pressure ulcer staging system because anatomical tissue comparisons cannot be made.
    • REVISED: If a pressure ulcer is surgically closed repaired
    • NEW: M0300D Stage 4 PU Coding Tips:
      • Cartilage serves the same anatomical function as bone.  Therefore, pressure ulcers that have exposed cartilage should be classified as a Stage 4.
      • NOTE: Term ‘numerical staging’ is substituted for worsened, current, and was, as appropriate
    • REVISED:  M1040H MASD:  Moisture associated skin damage (MASD) is a result of skin damage caused by moisture rather than pressure. It is caused by sustained exposure to moisture which can be caused, for example, by incontinence, wound exudate and perspiration. It is characterized by inflammation of the skin, and occurs with or without skin erosion and/or infection. MASD is also referred to as incontinence-associated dermatitis and can cause other conditions such as intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dematitis. Provision of optimal skin care and early identification and treatment of minor cases of MASD can help avoid progression and skin breakdown.
  3. O0100M, O-5
    • Hyperlinks updated

The most significant change was featured in Chapter 5 and addresses the error correction policy. This can positively impact revenue. In April 2012, CMS stated that facilities could not use the modification process to correct errors in ARD date, Types of Assessments, etc. This caused facilities to lose significant revenue for a simple typo or error. This revision corrects the process and provides a few good examples.

Note: The ARD (Item A2300) can be modified when the ARD on the assessment represents a data entry/typographical error. However, the ARD cannot be altered if it results in a change in the look back period and alters the actual assessment timeframe.

Prior to May 19, 2013, an inactivation request was required to address errors in the following items:

  • A0200: Type of Provider
  • A0310: Type of Assessment
  • A1600: Entry Date (on Entry tracking record; A0310F = 1)
  • A2000: Discharge Date (on Discharge/Death in Facility record;A0310F = 10-12)
  • A2300: Assessment Reference Date (ARD)

A modification was required for errors for clinical Items (B0100–V0200C), including data entry errors.

Effective May 19, a modification may now be used for typographical errors in the following items:

  • A0310: Type of Assessment; where there is no Item Set Code (ISC) change.
  • A1600: Entry Date
  • A2000: Discharge Date
  • A2300: Assessment Reference Date (ARD)
  • Clinical Items (B0100–V0200C)

An inactivation request is still required for errors in the following items:

  • A0200: Type of Provider
  • A0310: Type of Assessment; where there is an ISC change.

Click here to access the updated manual.