Step-by-Step Coding Guide for Item Set E0200: Behavioral Symptoms - Presence & Frequency

1. Review of Medical Records

Begin by examining the resident's medical records for any documentation of behavioral symptoms. Look for notes from healthcare providers, behavioral assessments, nursing notes, and any reported incidents that might indicate behavioral symptoms. Pay attention to the last 7 days for accurate coding.

2. Understanding Definitions

• Behavioral Symptoms: Include physical, verbal, and other actions that may be disruptive or dangerous to the resident or others. Examples are physical aggression, verbal aggression, other disruptive behaviors, and rejection of care.
• Physical aggression: Hitting, kicking, biting, or attacking others.
• Verbal aggression: Threatening, screaming at others, or using offensive language.
• Other disruptive behaviors: Inappropriate or unsafe behaviors not classified as physical or verbal aggression.
• Rejection of care: Refusal or resistance to assistance with activities of daily living (ADLs), treatments, medications, or dietary restrictions.

3. Coding Instructions

• E0200A (Physical Behavioral Symptoms Directed at Others): Observe and consult staff about any physical aggression. Consider incidents where the resident was hitting, biting, or attacking others.
• E0200B (Verbal Behavioral Symptoms Directed at Others): Document any verbal aggression, including threatening others or screaming.
• E0200C (Other Behavioral Symptoms Not Directed at Others): Note behaviors like public sexual acts, disrobing in public, or smearing/throwing food that are disruptive but not directed at others.
• E0200D (Rejection of Care): Record instances where the resident refuses or resists care related to ADLs, treatments, or medications.

For each item, code presence and frequency:

• 0: Not exhibited.
• 1: Behavior of this type occurred 1 to 3 days in the last 7 days.
• 2: Behavior of this type occurred 4 to 6 days, but less than daily.
• 3: Behavior of this type occurred daily.

4. Coding Tips

• Rely on multiple sources for information, including direct observation and reports from various staff members who interact with the resident.
• Understand that a resident's refusal of care might stem from unmet needs or discomfort; it's not always a direct refusal.

5. Documentation

• Document specific examples and frequencies of behaviors to support coding choices.
• Note interventions tried, their outcomes, and any changes to the care plan as a result of the behaviors.

6. Common Errors to Avoid

• Overlooking behaviors that might occur during certain times of day or night. Ensure 24-hour coverage in observations.
• Confusing isolated incidents with patterns of behavior. Look for recurring behaviors.
• Failing to consider the resident's perspective or possible reasons behind the rejection of care.

7. Practical Application

• Scenario: A resident exhibits verbal aggression towards staff when assisted with morning care. The behavior was reported 3 times over the past week.
• Coding: E0200B would be coded as 1 since the behavior occurred 1 to 3 days in the last 7 days.
• Intervention: Explore the cause of aggression. Is the resident uncomfortable or in pain during morning care? Adjust care practices accordingly.

The Step-by-Step Coding Guide for item E0200 in MDS 3.0 Section E 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.