Step-by-Step Coding Guide for Item Set D0150A2: PHQ Resident: Little Interest or Pleasure - Frequency

1. Review of Medical Records

• Objective: Gather accurate information regarding the frequency of the resident’s experience of little interest or pleasure.
• Steps:
  1. Collect Information: Review the resident’s comprehensive medical records, including previous assessments, nursing notes, and progress notes.
  2. Identify Symptoms: Look for documented instances where the resident reported or showed signs of having little interest or pleasure in activities.
  3. Confirm Observations: Verify these symptoms through consistent documentation and resident interviews.

2. Understanding Definitions

• Little Interest or Pleasure: This refers to the resident experiencing a noticeable lack of interest or pleasure in almost all activities, which is a symptom assessed in the PHQ-9.
• PHQ-9 (Patient Health Questionnaire-9): A nine-item questionnaire used to screen for the presence and severity of depression, which includes an item on little interest or pleasure.

3. Coding Instructions

• Steps:
  1. Conduct the Interview: Utilize the PHQ-9 to interview the resident about their interest or pleasure in activities.
  2. Identify Frequency: Determine the frequency of little interest or pleasure based on the resident’s self-report during the interview.
  3. Code Appropriately: Code D0150A2 based on the resident’s response:
     • 0: Never or 1 day
     • 1: 2-6 days
     • 2: 7-11 days
     • 3: 12-14 days

4. Coding Tips

• Accurate Assessment: Ensure the resident understands the question and is comfortable providing honest responses.
• Clarify Definitions: Make sure the resident understands what is meant by little interest or pleasure to ensure accurate reporting.
• Consistent Terminology: Use consistent terminology when documenting and coding the resident’s responses.

5. Documentation

• Required:
  • Interview Notes: Record the exact question asked and the resident’s verbatim response.
  • Assessment Records: Completed PHQ-9 assessments that include the resident’s responses regarding their interest or pleasure in activities.
  • Progress Notes: Document any relevant observations about the resident’s behavior or condition during the interview.

6. Common Errors to Avoid

• Leading Questions: Avoid leading the resident to a particular response. Ensure the resident provides their own assessment.
• Inconsistent Timing: Conduct the interview at a consistent time to avoid confusion and ensure the resident is oriented.
• Inadequate Documentation: Ensure all aspects of the interview and the resident’s responses are thoroughly documented.

7. Practical Application

• Example:
  • Resident Profile: Alice, an 80-year-old resident, is being assessed for depression.
  • Steps:
    1. Conduct Interview: The nurse asks Alice, “Over the last two weeks, how often have you had little interest or pleasure in doing things?”
    2. Record Response: Alice responds, “I’ve felt like that about half the days.”
    3. Evaluate and Code: Since Alice indicates she felt this way for about half the days (7-11 days), the nurse codes D0150A2 as "2".
  • Outcome: Alice’s frequency of experiencing little interest or pleasure is accurately documented and coded, ensuring appropriate follow-up and care planning.

Please note that the information provided in this guide for MDS 3.0 Item set D0150A2 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.