I5950: Psychotic Disorder (Other Than Schizophrenia), Step-by-Step

Step-by-Step Coding Guide for Item set I5950: Psychotic Disorder (Other Than Schizophrenia)

1. Review of Medical Records

• Objective: To verify a diagnosis of a psychotic disorder other than schizophrenia for accurate MDS coding.
• Process:
  • Review psychiatrist and psychologist evaluations and notes for diagnostic information.
  • Check physician orders and nursing notes for mentions of psychotic symptoms and related treatments.
  • Examine the medication administration record (MAR) for antipsychotic medications that could indicate treatment for psychotic disorders.

2. Understanding Definitions

• Psychotic Disorder (Other Than Schizophrenia): Includes disorders such as schizoaffective disorder, delusional disorder, brief psychotic disorder, and psychotic disorder due to another medical condition. These disorders are characterized by symptoms such as delusions, hallucinations, disorganized thinking, and grossly disorganized or abnormal motor behavior.

3. Coding Instructions

• Code I5950:
  • 0: No known diagnosis of a psychotic disorder other than schizophrenia.
  • 1: Known diagnosis of a psychotic disorder other than schizophrenia.
• Example: If a resident is diagnosed with schizoaffective disorder, code I5950 as '1'.

4. Coding Tips

• Ensure the diagnosis is current and actively managed or monitored during the assessment period.
• Distinguish between active symptoms and historical diagnoses that are no longer symptomatic or being treated.

5. Documentation

• Required Documentation:
  • A current and clear diagnosis from a qualified healthcare provider.
  • Documentation of symptoms or treatment specific to the diagnosed psychotic disorder.
  • Updates in the care plan reflecting management strategies for the disorder.
• Accurate and thorough documentation is crucial for compliance and care quality.

6. Common Errors to Avoid

• Coding based on outdated diagnoses without current symptoms or treatment.
• Confusing schizophrenia with other psychotic disorders.
• Missing documentation updates when a new diagnosis is made or an old diagnosis is ruled out.

7. Practical Application

• Scenario: During a routine evaluation, a resident who exhibits delusions and has significant mood swings is assessed by a mental health professional and diagnosed with schizoaffective disorder. The interdisciplinary team updates the care plan to include management strategies such as medication adjustments and therapeutic activities. This diagnosis and treatment are clearly documented in the resident's medical record, and I5950 is coded as '1' to reflect this active condition.

Please note that the information provided in this guide for MDS 3.0 Item set I5950 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.