MDS Calculator

CMI
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Welcome to the Broad River Rehab MDS Calculator!

With this calculator you can explore how different items in the MDS effect reimbursement.

The calculator supports All groupers.

  • Medicare Part A (legacy only) - use 66 - RUG IV and select your state or county
  • Medicaid - select the appropriate grouper and state:
    • 57 - RUG IV (OH & WA)
    • 48 - RUG IV (IL, IN, MD, MN, MS, RI, TN, VA & WI)
    • 53 - RUG III (NY)
    • 44 - RUG III (PA & VT)
    • 34 - RUG III (CO, GA, IA, KY, LA, NC, NE, NH, SD & TX)

Section A - Identification Information

A0200 - Type of Provider
 
A0310 - Type of Assessment
A. Federal OBRA Reason for Assessment
B. PPS Assessments
C. PPS Other Medicare Required Assessment - OMRA
D. Is this a Swing Bed change assessment? (Complete only if A0200 = 2)
A2300. Assessment Reference Date
A2400. Medicare Stay
B. Start date of most recent Medicare stay
C. End date of most recent Medicare stay

Hearing, Speech and Vision

B0100. Comatose
B0700. Makes Self Understood
Ability to express ideas and wants, consider both verbal and non-verbal expression

Cognitive Patterns

Brief Interview for Mental Status (BIMS)

C0200. Repitition of Three Words
Ask resident: “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are: sock, blue, and bed. Now tell me the three words.”
Number of words repeated after first attempt.
After the resident's first attempt, repeat the words using cues ("sock, something to wear; blue, a color; bed, a piece of furniture"). You may repeat the words up to two more times.

C0300. Temporal Orientation (orientation to year, month, and day).
Ask resident: "Please tell me what year it is right now."
A. Able to report correct year.
Ask resident: "What month are we in right now?"
B. Able to report correct month.
Ask resident: "What day of the week is today?"
C. Able to report correct day of week

C0400. Recall
Ask resident: "Let's go back to an earlier question. What were those three words that I asked you to repeat?" If unable to remember a word, give cue (something to wear; a color; a piece of furniture) for that word.
A. Able to recall "sock".
B. Able to recall "blue".
A. Able to recall "bed".

C0500. BIMS Summary Score

Do not conduct the following if Brief Interview for Mental Status (C0200-C0500) was completed

C0700. Short-term Memory OK
Seems or appears to recall after 5 minutes

C1000. Cognitive Skills for Daily Decision Making
Made decisions regarding tasks of daily life.

Section D - Mood

D0200 - Resident Mood Interview (PHQ-9)

Say to resident: "Over the last 2 weeks, have you been bothered by any of the following problems?"

If symptom is present, enter 1 (yes) in column 1, Symptom Presence. If yes in column 1, then ask the resident: "About how often have you been bothered by this?" Read and show the resident a card with the symptom frequency choices. Indicate response in column 2, Symptom Frequency.

1. Symptom Presence
0. No (enter 0 column 2)
1. Yes (enter 0-3 in column 2)
9. No response (leave column 2 blank) 		2. Symptom Frequency
0. Never or 1 day
1. 2-6 days (several days)
2. 7-11 days (half or more of the days)
3. 12-14 days (nearly every day) 		1. Symptom Presence 2. Symptom Frequency
A. Little interest or pleasure in doing things.
B. Feeling down, depressed, or hopeless.
C. Trouble falling or staying asleep, or sleeping too much.
D. Feeling tired or having little energy.
E. Poor appetite or overeating.
F. Feeling bad about yourself - or that you are a failure or have let yourself or your family down.
G. Trouble concentrating on things, such as reading the newspaper or watching television
H. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.
I. Thoughts that you would be better off dead, or of hurting yourself in some way.
D0300. Total Severity Score
Add scores for all frequency responses in Column 2, Symptom Frequency. Total score must be between 00 and 27. Enter 99 if unable to complete interview (i.e., Symptom Frequency is blank for 3 or more items).

D0500 - Staff Asssessment of Resident Mood (PHQ-9-OV)

Do not conduct if Resident Mood Interview (D0200-D0300) was completed.

Over the last 2 weeks, did the resident have any of the following problems or behaviors?

If symptom is present, enter 1 (yes) in column 1, Symptom Presence. Then move to column 2, Symptom Frequency, and indicate symptom frequency.

1. Symptom Presence
0. No (enter 0 column 2)
1. Yes (enter 0-3 in column 2)
9. No response (leave column 2 blank) 		2. Symptom Frequency
0. Never or 1 day
1. 2-6 days (several days)
2. 7-11 days (half or more of the days)
3. 12-14 days (nearly every day) 		1. Symptom Presence 2. Symptom Frequency
A. Little interest or pleasure in doing things.
B. Feeling or appearing down, depressed, or hopeless.
C. Trouble falling or staying asleep, or sleeping too much.
D. Feeling tired or having little energy.
E. Poor appetite or overeating.
F. Indicating that s/he feels bad about self, is a failure, or has let self or family down.
G. Trouble concentrating on things, such as reading the newspaper or watching television
H. Moving or speaking so slowly that other people have noticed. Or the opposite - being so fidgety or restless that s/he has been moving around a lot more than usual.
I. States that life isn't worth living, wishes for death, or attempts to harm self.
J. Being short-tempered, easily annoyed.
D0600. Total Severity Score
Add scores for all frequency responses in Column 2, Symptom Frequency. Total score must be between 00 and 30. Enter 99 if unable to complete interview (i.e., Symptom Frequency is blank for 3 or more items).

Behavior

E0100. Psychosis

A. Hallucinations (perceptual experiences in the absence of real external sensory stimuli).
B. Delusions (misconceptions or beliefs that are firmly held, contrary to reality).

Behavioral Symptoms

Coding:
0. Behavior not exhibited.
1. Behavior of this type occurred 1 to 3 days.
2. Behavior of this type occurred 4 to 6 days, but less than daily.
3. Behavior of this type occurred daily.

E0200. Behavioral Symptoms - Presence and Frequency
A. Physical behavioral symptoms directed toward others (e.g., hitting, kicking, pushing, scratching, grabbing, abusing others sexually).
B. Verbal behavioral symptoms directed toward others (e.g., threatening others, screaming at others, cursing at others).
C. Other behavioral symptoms not directed toward others (e.g., physical symptoms such as hitting or scratching self, pacing, rummaging, public sexual acts, disrobing in public, throwing or smearing food or bodily wastes, or verbal/vocal symptoms like screaming, disruptive sounds).

E0800. Rejection of Care - Presence & Frequency.
Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? Do not include behaviors that have already been addressed (e.g., by discussion or care planning with the resident or family), and determined to be consistent with resident values, preferences, or goals.

E0900. Wandering - Presence & Frequency.
Has the resident wandered?

Section G - Functional Status (ADL)

Instructions for Rule of 3

  • When an activity occurs three times at any one given level, code that level.
  • When an activity occurs three times at multiple levels, code the most dependent, exceptions are total dependence (4), activity must require full assist every time, and activity did not occur (8), activity must not have occurred at all. Example, three times extensive assistance (3) and three times limited assistance (2), code extensive assistance (3).
  • When an activity occurs at various levels, but not three times at any given level, apply the following:
    • When there is a combination of full staff performance, and extensive assistance, code extensive assistance.
    • When there is a combination of full staff performance, weight bearing assistance and/or non-weight bearing assistance code limited assistance (2).
If none of the above are met, code supervision.
1. ADL Self-Performance. Code for resident's performance over all shifts - not including setup. If the ADL activity occurred 3 or more times at various levels of assistance, code the most dependent - except for total dependence, which requires full staff performance every time.
Coding:
Activity Occurred 3 or More Times.
0. Independent - no help or staff oversight at any time.
1. Supervision - oversight, encouragement or cueing.
2. Limited assistance - resident highly involved in activity; staff provide guided maneuvering
of limbs or other non-weight-bearing assistance.
3. Extensive assistance - resident involved in activity, staff provide weight-bearing support.
4. Total dependence - full staff performance every time during entire 7-day period.
Activity Occurred 2 or Fewer Times.
7. Activity occurred only once or twice - activity did occur but only once or twice.
8. Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period.
2. ADL Support Provided.
Code for most support provided over all shifts; code regardless of resident's selfperformance classification. Coding:
0. No setup or physical help from staff.
1. Setup help only.
2. One person physical assist.
3. Two+ persons physical assist.
8. ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period.
  Self Support Score Total RCS-1 RCS Total
A. Bed mobility - how resident moves to and from lying position, turns side to side, and positions body while in bed or alternate sleep furniture  
B. Transfer - how resident moves between surfaces including to or from: bed, chair, wheelchair, standing position (excludes to/from bath/toilet).
H. Eating - how resident eats and drinks, regardless of skill. Do not include eating/drinking during medication pass. Includes intake of nourishment by other means (e.g., tube feeding, total parenteral nutrition, IV fluids administered for nutrition or hydration).
I. Toilet use - how resident uses the toilet room, commode, bedpan, or urinal; transfers on/off toilet; cleanses self after elimination; changes pad; manages ostomy or catheter; and adjusts clothes. Do not include emptying of bedpan, urinal, bedside commode, catheter bag or ostomy bag.

Bladder and Bowel

H0200 - Urinary Toileting Program
C. Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?
H0500 - Bowel Toileting Program
Is a toileting program currently being used to manage the resident's bowel continence?

Active Diagnoses

Active Diagnoses in the last 7 days - Check all that apply
Infections
I2000. Pneumonia.
I2100. Septicemia
Metabolic
I2900. Diabetes Mellitus (DM) (e.g., diabetic retinopathy, and neuropathy)
Neurological
I4300. Aphasia
I4400. Cerebral Palsy
I4900. Hemiplegia or Hemiparesis
I5100. Quadriplegia
I5200. Multiple Sclerosis
I5300. Parkinson's Disease
Pulmonary
I6200. Asthma, Chronic Obstructive Pulmonary Disease (COPD), or Chronic Lung Disease (e.g., chronic bronchitis and restrictive lung diseases such as asbestosis).
I6300. Respiratory Failure

Health Conditions

Other Health Conditions

J1100. Shortness of Breath (dyspnea)
C. Shortness of breath or trouble breating when lying flat.
J1550. Problem Conditions
A. Fever
B. Vomiting
C. Dehydrated
D. Internal Bleeding

Swallowing/Nutrional Status

K0300. Weight Loss

Loss of 5% or more in the last month or loss of 10% or more in last 6 months.


A. Parenteral/IV feeding.

 1. While NOT a Resident
 2. While a Resident

K0510. Nutrional Approaches

B. Feeding Tube - nasogastric or abdominal (PEG).
 1. While NOT a Resident
 2. While a Resident

K0710. Percent Intake by Artificial Route - Complete K0710 only if Column 1 and/or Column 2 are checked for K0510A and/or K0510B.

A. Proportion of total calories the resident received through parenteral or tube feeding during entire 7 days

B. Average fluid intake per day by IV or tube feeding during entire 7 days

Skin Conditions

M0300 - Presence of Pressure Ulcer

A. Number of Stage 1 pressure ulcers
Stage 1:Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have a visible blanching; In dark skin tones only it may appear with persistent blue or purple hues.
B1. Number of Stage 2 pressure ulcers. If 0 Skip to M0300C, Stage 3.
C1. Number of Stage 3 pressure ulcers. If 0 Skip to M0300D, Stage 4.
D1. Number of Stage 4 pressure ulcers. If 0 Skip to M0300E, Unstageable - Non-removable dressing.
F1. Unstageable - Slough and/or eschar: Known but not stageable due to coverage of wound bed by slough and/or eschar.

M1030 Number of Venous and Arteral Ulcers - M1200 Skin and Ulcer Treatments

M1030. Number of Venous and Arterial Ulcers.
Enter the total number of venous and arterial ulcers present.
M1040. Other Ulcers, Wounds and Skin Problems.
Foot Problems
A. Infection of the foot (e.g., cellulitis, purulent drainage).
B. Diabetic foot ulcer(s).
C. Other open lesion(s) on the foot.
Other Problems
D. Open lesion(s) other than ulcers, rashes, cuts (e.g., cancer lesion).
E. Surgical wound(s).
F. Burn(s) (second or third degree).
M1200. Skin and Ulcer Treatments.
A. Pressure reducing device for chair.
B. Pressure reducing device for bed.
C. Turning/repositioning program.
D. Nutrition or hydration intervention to manage skin problems.
E. Pressure ulcer care.
F. Surgical wound care.
G. Application of nonsurgical dressings (with or without topical medications) other than to feet.
H. Applications of ointments/medications other than to feet.
I. Application of dressings to feet (with or without topical medications).

Medications

N0300. Injections
Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry.
N0350. Insulin
A. Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days.
B. Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days.

Section O - Special Treatments & Procedures

O0100 - Special Treatments & Programs

Check all of the following treatments, programs and procedures that were performed during the last 14 days.

1. While NOT a Resident Procedure performed while NOT a resident of this facility and within the last 14 days. Only check column 1 if the resident entered (admission or reentry) IN THE LAST 14 DAYS. If resident last entered 14 or more days ago, leave column 1 blank.

2. While a ResidentProcedure performed while a resident of this facility and within the last 14 days

  1. While NOT a Resident 2. While a Resident
Cancer Treatments
A. Chemotherapy
B. Radiation
Respiratory Treatments
C. Oxygen Therapy
D. Suctioning
E. Tracheostomy Care
F. Ventilator or Respirator
Other
H. IV Medications
I. Transfusions
J. Dialysis
M. Isolation or Quarantine for active infectious disease  

O0400. Therapies - O0450 Resumption of Therapy

A. Speech Language Pathology and Audiology Services
(ongoing)

B. Occupational Therapy
(ongoing)

C. Physical Therapy
(ongoing)

- Record the number of days respiratory therapy was administered for at least 15 minutes a day in the last 7 days.

Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days.

Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline?

O0500 Restorative Nursing Programs - O0700 Physician Orders

Record the number of days each of the following restorative programs was performed (for at least 15 minutes a day) in the last 7 calendar days (enter 0 if none or less than 15 minutes daily).
Technique
A. Range of Motion (passive)
B. Range of Motion (active)
C. Splint or brace assistance
Training and Skill Practice In:
D. Bed Mobility
E. Transfer
F. Walking
G. Dressing and/or grooming
H. Eating and/or swallowing
I. Amputation/prosthesis care
J. Communication
 
O0600. Physician Examinations
Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident?
O0700. Physician Orders
Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders?

RUG III Legacy Items

T1. Special Treatments and Procedures

b. Ordered Therapies - Has physician ordered any of following therapist to begin in FIRST 14 days of stay: physical therapy, occupational therapy, or speech pathology service?
c. Through day 15, provide an estimate of the number of days when at least 1 therapy service can be expected to have been delivered.
d.Through day15, provide an estimate of the number of therapy minutes (across the therapies) that can be expected to be delivered.
1-800-596-7234
"A better way to do therapy."

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