Step-by-Step Coding Guide for Item Set D0150F2: PHQ-9 - Feeling Bad About Self - Frequency

1. Review of Medical Records

• Examine the resident’s medical record to identify any previous documentation of feelings of worthlessness or self-deprecation.
• Pay attention to notes from various healthcare professionals, including physicians, nurses, and mental health providers, for any indication of the resident expressing feelings of being a failure or letting themselves or their family down.

2. Understanding Definitions

• Feeling Bad About Self: Refers to a person’s internal experience of self-worth, including feelings of being a failure or having let oneself or others down.
• Frequency Coding:
  • 0 (Never or 1 day): The resident reports never or only once feeling bad about themselves in the past two weeks.
  • 1 (2-6 days): The resident reports feeling bad about themselves for several days in the past two weeks.
  • 2 (7-11 days): The resident reports feeling bad about themselves for more than half of the days in the past two weeks.
  • 3 (12-14 days): The resident reports feeling bad about themselves nearly every day in the past two weeks.

3. Coding Instructions

• Conduct the resident interview using the PHQ-9 questionnaire.
• Ask the resident: "Over the last two weeks, how often have you felt bad about yourself — or that you are a failure or have let yourself or your family down?"
• Show the resident a cue card with response options: 0-1 days (Never), 2-6 days (Several days), 7-11 days (More than half the days), 12-14 days (Nearly every day).
• Record the resident’s response according to the provided categories.

4. Coding Tips

• Probing: If the resident gives a vague answer, use probing questions to clarify. For example, ask “Can you tell me more about that?” or “What do you mean by sometimes?”
• Echoing: Repeat the resident’s response to confirm accuracy. For example, “You mentioned feeling this way almost every day. Is that correct?”
• Disentangling: If the resident talks about multiple aspects, break the question into parts. For example, “How often did you feel bad about yourself?” and then “How often did you feel like you let your family down?”
• Documentation: Always document any additional comments or explanations given by the resident to provide context for their responses.

5. Documentation

• Ensure all coding is documented clearly in the resident’s medical record.
• Include any relevant notes from the interview that provide context to the coded responses.
• Record any observations that may impact the resident’s responses, such as cognitive impairments or communication barriers.

6. Common Errors to Avoid

• Misinterpreting Responses: Ensure you understand the resident’s response fully before coding. Avoid making assumptions without clarification.
• Incomplete Interviews: If a resident is unable or unwilling to complete the interview, document this appropriately and use staff assessments where necessary.
• Bias in Coding: Avoid letting your perceptions or prior knowledge about the resident influence the coding. Record the resident’s response as given.

7. Practical Application

• Example 1:
  • Interview: “Over the last two weeks, how often have you felt bad about yourself or that you are a failure or have let yourself or your family down?”
  • Resident Response: “I feel like this nearly every day.”
  • Coding: D0150F1 (Symptom Presence) = 1 (Yes), D0150F2 (Symptom Frequency) = 3 (Nearly every day)
• Example 2:
  • Interview: “Over the last two weeks, how often have you felt bad about yourself or that you are a failure or have let yourself or your family down?”
  • Resident Response: “Maybe a few days, but not too often.”
  • Probing: “Can you tell me how many days exactly?”
  • Resident Response: “About 4 or 5 days.”
  • Coding: D0150F1 (Symptom Presence) = 1 (Yes), D0150F2 (Symptom Frequency) = 1 (Several days)

Please note that the information provided in this guide for MDS 3.0 Item set D0150F2 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.