Step-by-Step Coding Guide for Item Set E0500B: Behavioral Symptoms Interfere with Resident Care

1. Review of Medical Records

• Objective: Gather accurate information regarding the resident’s behavioral symptoms and their impact on resident care.
• Steps:
  1. Collect Information: Review the resident's medical records, including nursing notes, behavioral health assessments, and incident reports.
  2. Identify Behavioral Symptoms: Look for documented instances of behaviors that interfere with the provision of resident care.
  3. Confirm Impact: Verify how these behaviors have impacted the resident’s care as noted by healthcare staff.

2. Understanding Definitions

• Behavioral Symptoms: Actions by the resident that can include physical aggression, verbal outbursts, resistance to care, and other disruptive behaviors.
• Interference with Resident Care: Behaviors that prevent or hinder the provision of care, impacting the resident’s ability to receive proper treatment and assistance.

3. Coding Instructions

• Steps:
  1. Identify Interfering Behaviors: Confirm the presence of behavioral symptoms that interfere with resident care from the medical records.
  2. Verify Documentation: Ensure the impact of these behaviors on resident care is well-documented, including specific examples and outcomes.
  3. Code Appropriately: Code E0500B based on the frequency of interfering behaviors:
     • 0: Behavior 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

• Detailed Documentation: Ensure that all instances of interfering behaviors are thoroughly documented, including dates and specific actions.
• Consistent Terminology: Use consistent terminology when documenting and coding behavioral symptoms.
• Consult Behavioral Health Staff: If there is any uncertainty, consult with behavioral health professionals for clarification.

5. Documentation

• Required:
  • Behavioral Health Assessments: Detailed assessments of the resident’s behavior and its impact on care.
  • Nursing Notes: Document all instances of interfering behaviors and their impacts.
  • Incident Reports: Include any incident reports that detail behavioral disruptions.
  • Care Plans: Document how the care team is addressing and managing the interfering behaviors.

6. Common Errors to Avoid

• Misclassification: Ensure accurate classification of the frequency of interfering behaviors.
• Incomplete Documentation: Make sure all relevant details are thoroughly documented.
• Assumptions: Do not assume behaviors based on past history; document current behaviors and their impacts.

7. Practical Application

• Example:
  • Resident Profile: John, a 75-year-old resident, has been exhibiting behaviors that interfere with his ability to receive personal care.
  • Steps:
    1. Review Records: The nurse reviews John’s medical records, including nursing notes and incident reports documenting his disruptive behaviors.
    2. Identify Behavior: It is confirmed that John’s behaviors interfered with the provision of care on four days in the past week.
    3. Document and Code: The nurse documents the behaviors and codes E0500B as "2".
  • Outcome: John’s interfering behaviors are accurately documented and coded, ensuring proper follow-up and care planning.

Please note that the information provided in this guide for MDS 3.0 Item set E0500B 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.