Step-by-Step Coding Guide for Item Set A0310G: Planned/Unplanned Discharge

This guide focuses on accurately coding and documenting whether a discharge from the facility was planned or unplanned in the MDS 3.0, specifically within item A0310G.

1. Review of Medical Records

• Objective: Determine the nature of the resident's discharge.
• Key Points:
  • Examine the resident's medical record, care plans, and discharge planning notes to identify indications of whether the discharge was anticipated (planned) or occurred unexpectedly (unplanned).
  • Review communication with the resident, family, and healthcare providers regarding discharge planning.

2. Understanding Definitions

• Objective: Clarify the difference between planned and unplanned discharges.
• Key Points:
  • Planned Discharge: Occurs when the discharge process follows a pre-determined plan, often involving preparation and coordination with the resident, their family, and possibly external services or facilities.
  • Unplanned Discharge: Occurs unexpectedly, without prior arrangements, often due to sudden changes in the resident's health status, emergency situations, or other unforeseen circumstances.

3. Coding Instructions

• Objective: Guide on accurately selecting the discharge type.
• Key Points:
  • Code as "1" for a planned discharge, indicating that the discharge was expected and prepared for in advance.
  • Code as "2" for an unplanned discharge, indicating that the discharge occurred unexpectedly.

4. Coding Tips

• Ensure thorough review of the circumstances leading to discharge to accurately distinguish between planned and unplanned discharges.
• Consult with interdisciplinary team members if unsure, to gain a comprehensive view of the discharge process.

5. Documentation

• Objective: Maintain detailed documentation regarding the nature of the discharge.
• Key Points:
  • Document discussions, meetings, or plans related to the discharge process in the resident's medical record, specifying whether the discharge was planned or unplanned.
  • Keep records of any sudden incidents or changes in health status that led to an unplanned discharge.

6. Common Errors to Avoid

• Misclassifying a discharge due to insufficient review of the discharge process or lack of clear documentation.
• Failing to consult interdisciplinary team notes or discussions that may provide insight into the planned nature of the discharge.

7. Practical Application

• Scenario: Mrs. Jane Smith was admitted to the facility for post-operative care following knee surgery. A discharge plan was developed involving physical therapy and coordination with a home health agency. Two days before the scheduled discharge, Mrs. Smith experienced an unexpected decline in her condition, requiring immediate hospitalization. Despite the initial plan, this discharge is coded as "2" for unplanned due to the sudden change in her health status necessitating hospital care.

The Step-by-Step Coding Guide for item A0310G in MDS 3.0 Section A is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.