NTA, Section J, & Nursing - Providing Therapy a Better Way

NTA, Section J, & Nursing

Presented by:

Verona Bair, RN, RAC-CT Clinical Reimbursement Specialist

Gina Tomcsik, LPTA, RAC-CT Director of Compliance and Regulatory Strategy

Karen Welsh, MA CCC-SLP, RAC-CT Director of Clinical Outcomes

NTA Cue Card



Therapy services and intellectual property provided by Functional Pathways. ?2019 All rights reserved. This information and materials was created by and is proprietary to Functional Pathways of Tennessee, LLC. Any unauthorized use, dissemination, distribution, or copying of this information and material, in whole or in part, is strictly prohibited.

MDS Section H

Missed Opportunity Case Scenario: NTA 0 ? Resident has ostomy; ? Ostomy not captured on MDS; ? Coded as always incontinent of bowel.

Correct Coding Opportunity Case Scenario: ? Ostomy H0100C=1 point; ? H0400 9-'not rated' (resident had an

ostomy)

Missed out on 1 point in the NTA count

Therapy services and intellectual property provided by Functional Pathways. ?2019 All rights reserved. This information and materials was created by and is proprietary to Functional Pathways of Tennessee, LLC. Any unauthorized use, dissemination, distribution, or copying of this information and material, in whole or in part, is strictly prohibited.

MDS Section I

Therapy services and intellectual property provided by Functional Pathways. ?2019 All rights reserved. This information and materials was created by and is proprietary to Functional Pathways of Tennessee, LLC. Any unauthorized use, dissemination, distribution, or copying of this information and material, in whole or in part, is strictly prohibited.

MDS Section I

Missed Opportunity Case Scenario: NTA=2 ? Resident has COPD and Diabetes Mellitus (DM) actively being treated; ? I2900 check marked for Active Diagnosis of DM; ? I6200 not checked for COPD but I8000 has ICD-10 code listed.

Correct Coding Opportunity Case Scenario: ? COPD I6200 checked= 2 points

Missed out on 2 additional points in the NTA count

Therapy services and intellectual property provided by Functional Pathways. ?2019 All rights reserved. This information and materials was created by and is proprietary to Functional Pathways of Tennessee, LLC. Any unauthorized use, dissemination, distribution, or copying of this information and material, in whole or in part, is strictly prohibited.

MDS Section I, M, O

Missed Opportunity Case Scenario: NTA=0 ? Resident has 2 days IV antibiotic in SNF for foot wound infection; ? Wound Infection Code not captured in I2500; ? Did not capture foot infection in M1040A/Other Open Lesion on Foot Code M1040B; ? IV not captured on MDS in section O0100H2;

Correct Coding Opportunity Case Scenario: ? Wound Infection Code I2500= 2 points; ? Foot Infection Code M1040A/Other Open Lesion on Foot M1040B= 1 point; ? IV in section O0100H2= 5 points.

Missed out on 8 point on the NTA count

Therapy services and intellectual property provided by Functional Pathways. ?2019 All rights reserved. This information and materials was created by and is proprietary to Functional Pathways of Tennessee, LLC. Any unauthorized use, dissemination, distribution, or copying of this information and material, in whole or in part, is strictly prohibited.

Multiple Use Medications

Medications can have multiple FDA approved purposes, depending on dose. For example, 1mg of Propecia, generic name Finasteride, is used to treat hair loss in men but at 5mg, it is used to treat an enlarged prostate (brand name Proscar). Fluoxetine is an antidepressant that is branded as both Sarafem and Prozac. Prozac has a variety of approved uses: major depressive disorder, obsessive compulsive disorder, bulimia, and panic disorder. Sarafem on the other hand does not have a generic version and is only approved for the treatment of a severe form of PMS, premenstrual dysphoric disorder (PMDD). Dilantin is an anticonvulsant medication to treat seizures and is also commonly used to treat behaviors in patients with Dementia. Benadryl is an antihistamine used to treat allergies and is also commonly used to treat insomnia. Trazodone, also known as Desyrel, is an antidepressant to treat depression and is also commonly used to treat insomnia. Raloxifene: The FDA approved Raloxifene to reduce the risk of invasive breast cancer in postmenopausal women in 2007. It was initially developed to treat osteoporosis Tamoxifen: This hormone therapy treats metastatic breast cancers, or those that have spread to other parts of the body, in both women and men, and it was originally approved in 1977. Thirty years later, researchers discovered that it also helps people with bipolar disorder by blocking the enzyme PKC, which goes into overdrive during the manic phase of the disorder.

*it is important that the nurse consults with the physician to determine and confirm the correct use of the medication for a resident for accurate recording of the medical conditions and the capturing of active diagnoses on the MDS.

Therapy services and intellectual property provided by Functional Pathways. ?2019 All rights reserved. This information and materials was created by and is proprietary to Functional Pathways of Tennessee, LLC. Any unauthorized use, dissemination, distribution, or copying of this information and material, in whole or in part, is strictly prohibited.

NTA Missed Opportunity- Medication

Resident was admitted to the hospital for a fall and pain in lower back. Resident is diagnosed with osteoarthritis of lower back and treated for pain then sent to a skilled nursing facility. The SNF admitting nurse was adding orders into the EMR and adds Humira with a diagnosis of Osteoarthritis of Spine. When MDS completed the Initial Medicare Assessment, she does not question the medication order for Humira being for Osteoarthritis of the Spine, which is captured in Item I3700 for Arthritis (e.g. degenerative joint disease (DJD, Osteoarthritis, and rheumatoid arthritis (RA). In the hospital H & P, it talks about the resident needing to continue to take Humira for her Severe Psoriasis. The facility physician has written in his progress note in the first 5 days since SNF admission to continue the resident on Humira for severe Psoriasis. The Psoriasis diagnosis is not captured in I8000. Capturing a Severe Skin Burn or Condition in I8000 would gain 1 point for the NTA count.

Therapy services and intellectual property provided by Functional Pathways. ?2019 All rights reserved. This information and materials was created by and is proprietary to Functional Pathways of Tennessee, LLC. Any unauthorized use, dissemination, distribution, or copying of this information and material, in whole or in part, is strictly prohibited.

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