H0200A: Urinary Toileting Program: Has Been Attempted, Step-by-Step

Step-by-Step Coding Guide for Item Set H0200A: Urinary Toileting Program: Has Been Attempted

1. Review of Medical Records

• Thoroughly examine the resident's medical records to assess the history of urinary incontinence and any prior attempts at a toileting program.
• Look for details in nursing notes, care plans, physician orders, and therapy notes related to urinary continence management.

2. Understanding Definitions

• Urinary Toileting Program: A structured approach to managing urinary incontinence that may involve scheduled toileting, prompted voiding, or bladder retraining.
• Attempted: In the context of H0200A, this indicates whether a formal, documented trial of a toileting program has been initiated for the resident, regardless of the outcome.

3. Coding Instructions

• Code "1" for Yes if a trial of a toileting program has been attempted since the most recent admission/reentry or since urinary incontinence was first noted.
• Code "0" for No if no toileting program has been attempted, or if the resident is continent, uses a permanent catheter, or chooses not to participate.
• Code "9" for Unable to Determine if documentation is insufficient to confirm whether a trial was attempted.

4. Coding Tips

• Ensure that any trial is documented with specific start and end dates.
• Confirm that staff from all shifts are aware of and implementing the toileting program as prescribed.

5. Documentation

• Clearly record in the resident's care plan the details of the toileting program, including the schedule, staff instructions, and any resident preferences or refusals.
• Document each attempt at toileting, the resident's response, and any adjustments made to the program.

6. Common Errors to Avoid

• Failing to document the initiation and specifics of the toileting trial.
• Incorrectly coding a toileting program as attempted when only casual or irregular assistance with toileting is provided.

7. Practical Application

• Example: A resident with dementia exhibits increased urinary incontinence. The care team decides to implement a prompted voiding program, scheduling attempts every two hours during waking hours. This trial begins on April 1st. Despite the resident's sporadic cooperation, all attempts are documented, showing that the program was indeed initiated and is considered an "attempted" toileting program. Therefore, H0200A should be coded as "1".

Please note that the information provided in this guide for MDS 3.0 Item set H0200A 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.