E0800. Rejection of Care - Presence & Frequency, Step-by-Step

Step-by-Step Coding Guide for E0800. Rejection of Care - Presence & Frequency

1. Review of Medical Records

• Start by reviewing the resident's medical records for any documentation of rejection of care. This includes physician's orders, nursing notes, and care plans.
• Look for patterns of behavior that indicate refusal of care, treatments, medications, or interventions recommended or necessary to achieve the resident's goals for health and well-being.

2. Understanding Definitions

• Rejection of Care: Behaviors of a resident who refuses care or assistance that is necessary to achieve identified goals.
• Examples: Refusing to take medications, participate in physical therapy, allow wound care, or adhere to dietary restrictions.

3. Coding Instructions

• Code 0, No: If the resident did not exhibit any rejection of care behaviors during the 7-day look-back period.
• Code 1, Yes, 1-3 days: If rejection of care behaviors were observed 1 to 3 days during the 7-day look-back period.
• Code 2, Yes, 4-6 days: If observed 4 to 6 days.
• Code 3, Yes, daily: If observed daily.

4. Coding Tips

• Consistency is key: Ensure the behaviors are consistent with rejection of care and not due to misunderstanding or communication issues.
• Consider the resident's perspective: Sometimes refusal may stem from pain or fear.
• Document specifics: Note the type of care refused and the circumstances surrounding the refusal.

5. Documentation

• Detailed notes: Document each instance of care rejection, including date, time, type of care refused, and any resident explanations or staff observations.
• Care plan review: Document any adjustments to the care plan made in response to care rejection behaviors.

6. Common Errors to Avoid

• Overlooking subtle rejections: Not all rejections are overt; some may be passive.
• Failure to differentiate between refusal and inability: Ensure the refusal is not due to physical limitations or lack of understanding.
• Inconsistent documentation: Ensure all instances are documented promptly and accurately.

7. Practical Application

• Case Study Example: A resident refuses wound care for 3 consecutive days due to pain. Staff documented each refusal, attempted to understand the cause (pain), and adjusted the care plan to include pain management before wound care. The resident's refusal was coded as "Yes, 1-3 days".

The Step-by-Step Coding Guide for item E0800 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.