MDS Coding of Isolation in the Age of COVID-19

Stethoscope on a chart

Coding isolation on the minimum data set (MDS) is new territory for many MDS coordinators. Up until now, isolation has been a rare occurrence in long-term care. While there have been no changes to the Resident Assessment Instrument (RAI) Manual instructions for coding isolation, many MDS nurses are wondering if current isolation due to the SARS-CoV-2 virus and incidence of COVID-19 meets MDS coding definitions. 

The RAI Manual instructions for coding isolation in section O of the MDS at item O0100M2, “Isolation or Quarantine for Active Infectious Disease (while a resident),” including isolation of COVID-19, consist of four criteria that must be met for accurate MDS coding:

1.    Active Infection

A physician diagnosis of COVID-19 (U07.1) with active symptoms would meet the standard of a highly transmissible or epidemiologically significant pathogen. Demonstration of active infection in a contagious stage of illness would include evidence of COVID-19 symptoms and/or a positive lab test.  

Documentation: 

  • Physician diagnosis of active infection
  • Observe and document disease symptoms every shift  
  • Include positive lab results in the medical record 
  • Address isolation and include symptom observation and/or monitoring in the care plan

2.    Transmission-Based Precautions

Precautions taken must be over and above standard precautions. Accurate MDS coding would include contact, droplet or airborne precautions.

Documentation:

  • Routinely indicate the type of precaution implemented   
  • Include the type of precaution taken in the care plan

3.    No Roommate

The resident must be alone in the room (single room/private room isolation) due to an active infection and can’t have a roommate. Don’t code isolation when cohorted with another resident, even if the other resident is being treated or isolated for COVID-19.    

Documentation:  

  • Daily census records can assist in supporting single room isolation  
  • Address placement in a private room in the care plan

4.    Must Remain in Room

All services must be provided in the resident’s room. This includes meals, activities and all therapies. The resident can’t leave the room while in isolation.

Documentation:

  • Address the isolation and all services provided in room
  • Include single room isolation and services provided in room in the care plan
  • Indicate interventions to prevent social isolation in the care plan

Flow sheets or documentation on Treatment Administration Records can provide much of the documentation that supports coding of isolation on the MDS. A narrative progress note written by the MDS nurse during the 14-day observation period can further supplement supportive documentation for isolation.

Isolation provided at any time during the 14-day observation period can be coded on the MDS. Isolation doesn’t need to be maintained during the entire 14 days. Care should be taken when selecting an appropriate assessment reference date to consider the effect on reimbursement whenever possible.  

Accurate coding of isolation can have a significant positive effect on Medicare reimbursement under the Patient-Driven Payment Model (PDPM). Both the nursing case mix group (CMG) and the nontherapy ancillary (NTA) CMG include isolation as a qualifier.

Isolation is a qualifier for the Extensive Services “ES1” CMG for the PDPM’s nursing component. The ES1 CMG (indicated with a “C” in the Nursing column of the HIPPS code) has one of the highest nursing CMG weights. In addition, checking this box for isolation adds one point to the NTA count.  

For states using the RUG-IV grouper to calculate the Medicaid case mix, accurate coding of isolation also can have a significant positive effect on the daily Medicaid rate. RUG-IV categories that include isolation coding have some of the highest case mix weights.     

Correctly coding isolation is important to MDS accuracy and appropriate reimbursement as we navigate these challenging times. Visit BKD’s COVID-19 Resource Center to learn more. As with most topics related to COVID-19, changes are being made rapidly. Please note that this information is current as of the date of publication. If you have questions, please reach out to your BKD Trusted Advisor or use the Contact Us form below.

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