Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - News on Dr. Levine's medical and consulting practice, and reflections on our healthcare system.

Category: Minimum Data Set (MDS) 3.0

Common Questions on Coding for MDS 3.0 Section M: Skin Conditions

I recently gave another training session for nursing home professionals for MDS 3.0 Section M: Skin Conditions.  In the audience were nurses, directors of nursing, administrators, MDS coordinators and a smattering of physical therapists, doctors, and social workers.  After the didactic I fielded questions and decided to share the most common ones with my blog readers.  Question 1:  How do I code Section M0700 when …Read More

Straight Talk on Reverse Staging of Pressure Ulcers

The issue of “reverse staging” or “backstaging” of pressure ulcers as they heal is often a cause for confusion, even for some experts.  With this blog post I hope to clarify things and explain why reverse staging is now discouraged when assessing wounds, and place the issue in context with the revised Minimum Data Set (MDS) 3.0 Section M: Skin Conditions, which went into effect October …Read More

Does MDS 3.0 Section M Avoid the Unavoidable?

The revised Resident Assessment Instrument (RAI) with the new MDS 3.0 Section M: Skin Conditions radically expands the assessment process for pressure ulcers in Medicare certified skilled nursing facilities.  In contrast to the prior version, there are data fields for improving or deteriorating pressure ulcers, ulcer measurements, and tissue type at the base of the wound.  Important issues such as “present on admission” and updated …Read More

CMS Tightens Up Pressure Ulcer Classification in Long-term Care

Revised Minimum Data Set (MDS) 3.0 Section M: Skin Conditions greatly expands the process of skin assessment in nursing homes.  The accompanying Resident Assessment Instrument (RAI) Instruction Manual has instructions on how to identify and code pressure ulcers and other wounds using a methodology that is explicitly stated.  These instructions include the following: “If an ulcer arises from a combination of factors which are primarily …Read More

Geriatrics by Legislation: The Trend of the Future?

Recently Governor Paterson signed a law that mandates New York doctors to offer balanced information on choices for end-of-life care – a step in line with principles of geriatric practice and informed decision making.  All nursing homes are already mandated by regulation to perform assessments for such medical problems as delirium, depression, and pressure ulcers – assessments that will become more detailed and comprehensive on …Read More

Downloadable Resources for MDS 3.0 Section M: Skin Conditions

I received so many inquiries about resources for skin assessment in the nursing home that I devoted this blog post to providing links and downloads useful to wound care clinicians.  Below you can access PDFs which contain important information related to skin, pressure ulcer, and wound assessment that will be helpful to nurses, doctors, medical directors, inservice directors, MDS coordinators, and anyone else interested in this very important topic.  As you probably know, …Read More

Teaching America How to Assess Wounds

Last week I presented at the Center for Medicare and Medicaid Service’s (CMS) Train-the-Trainer program in Las Vegas for the introduction of Minimum Data Set (MDS) 3.0 which will go into effect October 1, 2010.  This assessment tool will impact 17,000 nursing homes and 1.6 million people who reside in them across America.  My assignment was to introduce Section M: Skin Condition, which represents the assessment for pressure …Read More

Long-Term Care Update: Resident Assessment Radically Changes with MDS 3.0

Hear ye!  Hear Ye!  RAPs are out!  CATs and CAAs are in! I chuckle as I write this blog post knowing that few of my regular readers will understand, and have probably clicked off by now.  But the few of you who remain know how important this topic is to long-term care.  On October 30, 2009 CMS finally released the RAI Users Manual V 3.0 which …Read More

Update on Blister Pressure Ulcer Staging from CMS for MDS 3.0 Section M: Skin Conditions

Another guest blog post by Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN Good news! Since the educational training programs held last March and April, CMS has reconsidered its original guidance regarding how to code blister pressure ulcers on the revised Minimum Data Set (MDS) version 3.0. Previously, CMS directed that any pressure ulcer that presents as a blister regardless of what type of …Read More

Elizabeth Ayello PhD, RN Blogs on MDS 3.0 sDTI Coding

Another guest post by Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN. I was pleased with the response to my first guest post on Dr. Levine’s healthcare blog.  One question in particular regarding suspected deep tissue injury (sDTI), written by Laura DiGiulio CWOCN, particularly deserves comment.  Laura asked: “I would like some guidance about how to integrate the new MDS3.0 guidelines related to staging …Read More