Step-by-Step Coding Guide for Item Set D0150I1: PHQ Res: Thoughts Better Off Dead - Presence

1. Review of Medical Records

• Objective: To identify whether the resident has expressed thoughts of being better off dead or of self-harm.
• Process:
  • PHQ-9 Assessments: Review the Patient Health Questionnaire (PHQ-9) assessments, specifically the responses to questions related to thoughts of self-harm or feeling better off dead.
  • Psychiatric Evaluations: Examine notes from psychiatric evaluations and consultations that discuss the resident’s mental health status.
  • Nursing and Caregiver Notes: Look at daily nursing notes, caregiver reports, and incident logs for any documented verbalizations or behaviors indicating self-harm ideation.
  • Interdisciplinary Team Discussions: Review records of team meetings where the resident’s mental health and any expressions of suicidal ideation were discussed.

2. Understanding Definitions

• Thoughts of Being Better Off Dead: This refers to the resident’s expressed belief or feeling that they would be better off dead or having thoughts of self-harm. It is a significant indicator of depression and requires immediate attention and intervention.

3. Coding Instructions

• Code D0150I1:
  • 0: No, the resident does not have thoughts of being better off dead or self-harm.
  • 1: Yes, the resident has thoughts of being better off dead or self-harm.
• Example: If a resident during their PHQ-9 assessment responds affirmatively to the question about having thoughts of being better off dead, code D0150I1 as '1'.

4. Coding Tips

• Ensure accurate and empathetic communication when asking residents about their mental health to get honest and complete responses.
• Consider all available documentation, including indirect references that might suggest such thoughts, and verify with direct assessments if necessary.

5. Documentation

• Required Documentation:
  • PHQ-9 Assessment Records: The resident’s completed PHQ-9 assessment showing their response to the question about self-harm thoughts.
  • Mental Health Notes: Detailed notes from mental health professionals that document any expressions of suicidal ideation.
  • Incident Reports: Reports of any incidents or behaviors indicating self-harm or thoughts of being better off dead.
  • Care Plan Updates: Documentation of any changes to the care plan addressing the resident’s mental health needs in response to these thoughts.
• Example: "On 06/10/2024, during a PHQ-9 assessment, the resident indicated they have had thoughts of being better off dead. A psychiatric consultation was requested, and the care plan was updated to include increased monitoring and therapeutic interventions."

6. Common Errors to Avoid

• Underreporting: Failing to document or code based on indirect or subtle indications of suicidal ideation.
• Misinterpretation: Misunderstanding the resident’s expressions or the context in which they were made.
• Incomplete Documentation: Not thoroughly documenting the resident’s responses, subsequent interventions, and changes in the care plan.

7. Practical Application

• Scenario: A resident undergoing a routine mental health assessment with the PHQ-9 indicates that they have had thoughts of being better off dead over the past two weeks. The nurse documents this response and informs the interdisciplinary team. A psychiatrist evaluates the resident, and a safety plan is developed and documented in the care plan, which includes increased supervision and scheduled counseling sessions. The coding for D0150I1 is updated to '1' to reflect the resident’s expressed thoughts of self-harm.

Please note that the information provided in this guide for MDS 3.0 Item set D0150I1 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.