CMS announced in the
QSO-23-05-NH memo it will be completing schizophrenia MDS audits in nursing homes. AHCA has provided the below summary to ensure members have the most updated information on coding schizophrenia on the MDS and information on the exclusion of the diagnosis on the quality measures.
The RAI manual gives instructions for coding Schizophrenia Item I6000 on the MDS. I6000 schizophrenia includes schizoaffective and schizophreniform disorders (p. 351). To code schizophrenia, it must be a current active diagnosis in the last 7 days. Page 352 defines active diagnosis as a physician-documented diagnosis in the last 60 days that has a direct relationship to the resident’s current functional status, cognitive status, mood or behavior, medical treatments, nursing monitoring, or risk of death during the 7-day look-back period. ‘Physician’ can be a nurse practitioner, physician assistant, or CNS.
The resident was admitted without a diagnosis of schizophrenia. After admission, the resident is prescribed an antipsychotic medication for schizophrenia by the primary care physician. However, the resident’s medical record includes no documentation of a detailed evaluation by an appropriate practitioner of the resident’s mental, physical, psychosocial, and functional status (§483.45(e)) and persistent behaviors for six months prior to the start of the antipsychotic medication in accordance with professional standards.
Coding: Schizophrenia item (I6000), would not be checked.
Rationale: Although the resident has a physician diagnosis of schizophrenia and is receiving antipsychotic medications, coding the
schizophrenia diagnosis would not be appropriate because of the lack of documentation of a detailed evaluation, in accordance with
professional standards (§483.21(b)(3)(i)), of the resident’s mental, physical, psychosocial, and functional status (§483.45(e)), and
persistent behaviors for the time period required.
Exclusions:
1. The following is true for all assessments in the look-back scan (excluding the initial assessment):
1.1. For assessments with target dates on or after 04/01/2012: (N0410A = [-]).
2. Any of the following related conditions are present on any assessment in a look-back scan:
2.1. Schizophrenia (I6000 = [1]).
2.2. Tourette’s syndrome (I5350 = [1]).
2.3. Huntington’s disease (I5250 = [1])
Accurate coding in the MDS is extremely important. Please utilize the above resources to assist with coding accuracy in the MDS. If you have questions regarding MDS coding or the quality measures, please email regulatory@ahca.org.