1. Review of Medical Record

• Objective: To check for a documented neurological diagnosis of comatose or persistent vegetative state.
• Action Steps:
  • Examine the medical records for any documented diagnosis by a physician, nurse practitioner, physician assistant, or clinical nurse specialist.
  • Focus on the 7-day look-back period relevant to the assessment.

2. Understanding the Definition

• Comatose: A pathological state where there is neither arousal (wakefulness, alertness) nor awareness. The person is unresponsive, cannot be aroused, doesn't open their eyes, speak, or move extremities on command or in response to noxious stimuli (like pain).

3. Coding Instructions

• Code 0 (No): If there is no diagnosis of coma or persistent vegetative state during the 7-day look-back period. Continue to B0200 (Hearing).
• Code 1 (Yes): If the record shows a documented diagnosis of coma or persistent vegetative state during the 7-day look-back period. Skip to Section GG (Functional Abilities and Goals).

4. Coding Tips

• Understanding the Condition: Be aware that severe cognitive impairment or non-communicative states in certain progressive neurological disorders (like advanced Alzheimer's) are different from being comatose.

5. Documentation

• Record Keeping: Ensure that the diagnosis and any relevant clinical observations are clearly documented in the resident’s medical records.
• Details: Include date and time of diagnosis and any observations relevant to the resident's state of consciousness.

6. Common Errors to Avoid

• Misinterpretation: Do not confuse severe cognitive impairment with being comatose.
• Inaccurate Look-Back Period: Ensure the diagnosis relates to the specified 7-day look-back period.

7. Practical Application

• Case Scenario: You might encounter a resident with a documented diagnosis of a persistent vegetative state following a severe brain injury. In this case, you would code B0100 as 1 (Yes).

The Step-by-Step Coding Guide for item B0100 in MDS 3.0 Section B 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.