Caryn Adams

Can you explain why my MDS nurse is refusing to code “isolation” on our residents in precautionary isolation for COVID-19?

While isolation for COVID-19 or any other infectious process can significantly enhance or improve our reimbursement rates, there are specific criteria that need to be met. The resident must require strict isolation. They also must be alone in a separate room because of active infection with a highly transmissible or epidemiologically significant pathogen.  

Isolation can be coded in section O-Item O0100M for any infection that meets these criteria:

1.  Active infection means that they are symptomatic and/or a positive test and in a contagious stage and the infection must be actively treated. For COVID-19, the treatment is rest and isolation. The 14-day isolation precaution for new admissions and readmissions for COVID-19 do not meet this criterion. 

2.  Standard precautions alone are not enough. The resident must require transmission-based precautions such as contact, droplet or airborne.

3.  The resident is in a room alone because of active infection and cannot be cohorted with a roommate.

4.  The resident must remain in his or her room. This means that all services (therapy, activities, dining) must come to them. If the resident meets the criteria as stated, capture it on the MDS. This will increase the nursing case mix component to ES1. 

I anticipate this being an area of scrutiny during medical review. It is crucial to ensure documentation is placed. Ensure that there is a documented active infection either through provider progress notes or test results. Nursing documentation should reflect the isolation precautions that were used, the symptoms the resident is having and that services were provided in the room.