RAI May Update

The American Health Care Association (AHCA) has reviewed the May 2013 RAI Updates.  The majority of the updates involves minor edits, grammatical corrections, restatements to improve clarity, and added web links.  A few updates are notable and include the following:

Chapter 2

  • Section 2.8, page 2-39 – The direction has previously stated that the 5-day Medicare Assessment Schedule, Assessment Reference Date (ARD) must be set on day 1 through 5.  The Update changed the ARD set from day 1 through 8.  Don’t be confused, the updated change incorporates the 3 grace days.  The Scheduled Medicare PPS Assessments, page 2-40 of the RAI Manual, clearly shows the ADR days 1-5 remains and the grace days 6-8.

Chapter 3

  • Section E0800 – Rejection of Care, page E-16, Example 3 - The number of days the rejection of care occurred was changed from 2 of the past 5 days to 2 of the past 7 days to be consistent with the number of potential days covered by the MDS E0800 data element.
  • Section L added a statement related to mouth pain and the need to also code oral pain in Section J under pain.  Example, resident having a tooth extraction or abscess and is now experiencing pain and it must be coded as such.
  • Section M0210, page M-5 adds Mucosal Ulcers, ulcers developing from mechanical devises like catheters or tubing, and identifies that these ulcers are NOT to be coded on the MDS.  The rationale for this is that pressure ulcer staging is bases on skin and not mucosa.  However, if the mucosal ulcer is related to the oral cavity, then it is coded in Section L, 0200 Abnormal Mouth Tissue.
  • Section M0300, page M-6 addresses coding obscure pressure ulcer tissue with wound depth that cannot be measured as unstageable.  However, if the wound bed is only partially covered by eschar or slough and tissue damage can be visualized or palpated, then the ulcer needs to be staged.  M0300, page M-15 adds a Coding Tip that a pressure ulcer having exposed cartilage needs to be classified as a Stage 4 ulcer.
  • Section M0800, page M-26 addresses wound debriedment and states that if by removing enough eschar and slough the wound becomes visible, the determination of wound worsening can be made.
  • Section M1040, page M-35 includes additional discussion language related to Moisture Associated Skin Damage (MASD).
  • Section X0300, page X-3 states that if a dash was used in a record at A0800 and a record correction is needed, then a dash must be used in X0300 so that the record can be found in the system.  Both A0800 and X0300 pertain to the gender.

Chapter 5

  • Section 5.7, pages 5-10 and 5-11 address updates to correcting ARD errors in the MDS.  Providers are now allowed to fix ARD typos.  Facilities can modify the record rather than inactivating it.  However, if the ADR correction changes the RUG score, it is not allowed.

Questions or comments regarding MDS coding and the recent updates should be directed to Cil Bullard, State RAI Coordinator at Priscilla.Bullard@vdh.virginia.gov or by phone at 804.367.2141.