A1250B: "Transportation- from NACHC: Yes, kept from non-medical appointments",step-by-step

Step-by-Step Coding Guide for Item Set A1250B: "Transportation (from NACHC©): Yes, kept from non-medical appointments"

1. Review of Medical Records

• Objective: Confirm whether the resident's medical or progress notes reflect transportation difficulties that have impacted their ability to attend non-medical appointments, events, or other essential activities over the past six months to a year.
• Procedure:
  • Examine notes from social services, care plan meetings, and any documented family input that indicates transportation barriers.
  • Look for any notes on transportation issues related to other life aspects, such as missing non-medical appointments or social gatherings due to lack of transport​.

2. Understanding Definitions

• Non-Medical Appointments or Events: This refers to any activities, meetings, or appointments unrelated to direct medical care, such as social gatherings, work obligations, or accessing community services.
• Transportation Barriers: A lack of reliable transport that prevents residents from accessing necessary non-medical activities, which may include community events, essential shopping, and social outings​.

3. Coding Instructions

• Code Options:
  • A1250A - Yes, kept from medical appointments: If transportation issues prevented attendance at medical-related appointments.
  • A1250B - Yes, kept from non-medical meetings/appointments: Use if transportation issues prevented attendance at non-medical meetings, activities, or appointments.
  • C - No: If transportation issues did not prevent the resident from accessing either medical or non-medical appointments.
  • X - Resident unable to respond: Use if the resident cannot answer, and no family or representative is available for input.
  • Y - Resident declines to respond: Code as "Y" if the resident chooses not to provide information about transportation barriers​​.

4. Coding Tips

• Ask Clarifying Questions: When discussing transportation with residents or family, clarify whether the transportation issue affects medical or non-medical appointments specifically.
• Multiple Responses: Residents may have transportation barriers affecting both medical and non-medical appointments. Record all applicable responses.
• Alternative Sources: If the resident is unable to respond, gather information from family, significant others, or legally authorized representatives. If no information is available, select “X” for unable to respond​.

5. Documentation

• Objective: Document any responses accurately to support coding, ensuring clarity about the type and impact of transportation barriers.
• Documentation Tips:
  • Log conversations with the resident or family regarding transportation issues, including specific examples of missed non-medical appointments.
  • If coded as “No,” confirm with the resident or family that transportation barriers were not an issue.
  • Record instances where family or significant others provide transportation solutions for the resident​.

6. Common Errors to Avoid

• Incorrect Coding for Non-Respondents: Avoid coding “Yes” or “No” without input from either the resident or a proxy if the resident cannot respond.
• Assumptions Based on Age or Condition: Do not assume transportation barriers based on a resident’s age, physical limitations, or medical condition unless documented.
• Dual Coding Without Proper Verification: Ensure that dual coding (for both A1250A and A1250B) is based on clear indications that the resident has faced transportation issues affecting both medical and non-medical appointments​.

7. Practical Application

• Scenario Example:
  • Resident L, who lives in a rural area, mentions that they missed several social club meetings due to lack of transportation. They also missed a friend’s birthday event because family members were unavailable to drive.
  • Coding: Code A1250B as Yes since transportation barriers clearly impacted non-medical appointments.
  • Documentation: Log these instances in progress notes, specifying the missed events to justify coding​.

Please note that the information provided in this guide for MDS 3.0 Item set A1250B was originally based on the CMS's RAI Version 3.0 Manual, October 2023 edition. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0.  

The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding.  

Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.