D0150I2: PHQ Resident Mood Interview - Thoughts Better Off Dead: Frequency, Step-by-Step

Step-by-Step Coding Guide for D0150I2: PHQ Resident Mood Interview – "Thoughts Better Off Dead: Frequency"

1. Review of Medical Records

Objective: Determine how frequently the resident has experienced thoughts of being better off dead or hurting themselves in the past two weeks, as part of the PHQ-9 depression screening.

Actions:

• Review prior assessments for any mention of suicidal thoughts or self-harm in the resident’s medical record.
• Conduct the PHQ-9 interview and ask the resident specifically about the frequency of these thoughts.

2. Understanding Definitions

D0150I2: Thoughts Better Off Dead assesses how often in the past two weeks the resident has experienced thoughts of death or self-harm.

Example Scenario:

• Resident A: Reports thinking they would be better off dead nearly every day for the past two weeks. This would be coded as 3: 12-14 days (nearly every day).

3. Coding Instructions

Step-by-Step:

• Step 1: Ask the resident: “In the past two weeks, how often have you been bothered by thoughts that you would be better off dead or thoughts of hurting yourself in some way?”
• Step 2: Record the frequency based on the resident’s response:
  • 0: Never or 1 day – If the resident reports no thoughts or only once in the past two weeks.
  • 1: 2-6 days (several days) – If the resident reports these thoughts occurring 2-6 days.
  • 2: 7-11 days (half or more of the days) – If the resident reports these thoughts occurring 7-11 days.
  • 3: 12-14 days (nearly every day) – If the resident reports these thoughts occurring nearly every day.
  • 9: No response – If the resident is unable or refuses to respond.

4. Coding Tips

• Sensitive Topic: Approach this question carefully. Ensure that the resident feels comfortable and understands that their answers are confidential and for the purpose of better care.
• Clarification: If the resident is unsure, gently probe by repeating or rephrasing the question.

5. Documentation

Objective: Record the frequency of the resident’s thoughts about being better off dead or self-harm, ensuring proper follow-up and care planning.

Actions:

• Document the exact frequency as reported by the resident.
• Ensure this information is shared with the care team for immediate follow-up and intervention if necessary.

6. Common Errors to Avoid

• Skipping the Question: Do not skip this question out of discomfort. It is essential for identifying serious mental health concerns.
• Assuming the Answer: Always rely on the resident’s response, even if observations suggest otherwise.

7. Practical Application

Example 1:
The resident reports these thoughts occurring on 10 days in the past two weeks. Code as 2: 7-11 days (half or more of the days).

Example 2:
A resident reports no such thoughts over the past two weeks. This should be coded as 0: Never or 1 day.

Please note that the information provided in this guide for MDS 3.0 Item set D0150I2 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.