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CMS Updates Isolation Coding on the MDS

The Minnesota Department of Health Case Mix Review team released information on updated documentation requirements when isolation is coded on the MDS under O0100M. This updated information will be effective for all MDS’ with an assessment reference date (ARD) on or after Friday, March 5. In order to correctly code O0100M, Isolation on the MDS, case mix review auditors will check for required documentation in the resident’s medical record. This required documentation includes:

  • Physician documentation that the resident is either symptomatic AND in the contagious stage; or, has a positive test AND is in the contagious stage. 
  • There should be documented evidence the physician is directing the medically necessary care required for isolation. 
  • Daily documentation regarding symptoms of infection
  • Daily documentation providing evidence the resident remained in strict isolation. Required elements of this documentation include documenting the resident was alone in the room, AND they did not leave their room unless they required a service that could not be provided within the facility; AND all services were brought to the resident including but not limited to meals, therapies, activities, bathing etc.
  • For COVID-19 infections the medical record must contain documentation of the symptom on set date if they are symptomatic and documentation of a positive COVID-19 test with the date of the test.

Isolation does carry a daily rate increase and providers should code isolation if it’s appropriate. Ensuring all of the documentation essentials exist in the medical record is not only important to obtain the increased revenue from care given to individuals in medically necessary isolation but also ensures a smooth case mix audit. If you have questions, please contact Kari Everson.

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