Examine residents' incontinence records, MDS expert advises

Leah Klusch, RN, BSN, FACHCA

Overcoding or undercoding incontinence in the MDS 3.0 is a problem in many long-term care facilities, an expert said Tuesday during a McKnight's Super Tuesday webcast.

“If you are coding that you have lots of elders who are always continent, you are going to have people asking you a question about that,” noted the Alliance Training Center's Leah Klusch, RN, BSN, FACHA. “That's not what we see in the national non-institutionalized population.”

Many nurses or providers are not looking at the definition of continence in Section H, which means “total control,” she said. Additionally, the proper use of continence products is important for risk managers and can be a sticking point for surveyors. 

Managers should make sure that their staff understands what the various toileting procedures are, what the coding is saying, and whether it demonstrates that everyone understands the definition, Klusch advised. A lack of good toileting procedures is one of the top reasons residents fall, putting the facility at legal risk. 

“There is a tremendous need for continence management. It needs to be accurate. This is a good example of an area that has not had adequate attention,” she warned.

Administrators and managers also need to make sure they have reviewed April changes to the MDS, are looking at their RUG distribution and are watching ADL levels. Additional updates to the RAI manual are expected by Oct. 1.

Additionally, changes continue for providers seeking payment from Medicare Part B for services above the therapy cap amount of $3,700. Providers must submit exceptions requests to a Medicare Administrative Contractor by one of three phased-in deadlines this fall.