A0310B: Type of Assessment: PPS, Step-by-Step

Step-by-Step Coding Guide for Item Set A0310B: Type of Assessment: PPS

1. Review of Medical Records

• Objective: Gather accurate information regarding the type of assessment being conducted.
• Steps:
  1. Collect Information: Review the resident's medical records, including previous assessments, admission records, and care plans.
  2. Identify Assessment Types: Look for documentation indicating the type of assessment being performed.
  3. Confirm PPS Assessment: Verify that the assessment is a Prospective Payment System (PPS) assessment.

2. Understanding Definitions

• PPS (Prospective Payment System): A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The PPS assessment type is used to determine the level of care and reimbursement rate for the resident’s stay in a skilled nursing facility.
• Types of PPS Assessments: Include various assessment schedules such as the 5-day, 14-day, 30-day, 60-day, and 90-day assessments.

3. Coding Instructions

• Steps:
  1. Identify the PPS Assessment Type: Confirm the specific PPS assessment being conducted (e.g., 5-day, 14-day, etc.).
  2. Verify Documentation: Ensure the assessment type is well-documented in the resident’s records.
  3. Code Appropriately: Code A0310B with the correct value corresponding to the type of PPS assessment:
     • 01: 5-day assessment
     • 02: 14-day assessment
     • 03: 30-day assessment
     • 04: 60-day assessment
     • 05: 90-day assessment
     • 06: Readmission/return assessment
     • 07: Other Medicare required assessment

4. Coding Tips

• Accurate Identification: Ensure the type of PPS assessment is correctly identified and documented.
• Consistent Terminology: Use consistent terminology when documenting and coding the type of assessment.
• Consult Records: If there is any uncertainty, consult with the facility’s billing or administrative staff for clarification.

5. Documentation

• Required:
  • Assessment Forms: Include completed PPS assessment forms that indicate the type and timing of the assessment.
  • Medical Records: Document all relevant medical records, including admission records and previous assessments.
  • Verification Notes: Ensure there are notes confirming the type of assessment being conducted.

6. Common Errors to Avoid

• Misclassification: Ensure accurate classification by verifying the type of PPS assessment being conducted.
• Incomplete Documentation: Make sure all relevant records and notes are included.
• Assumptions: Do not assume the type of assessment without proper documentation and verification.

7. Practical Application

• Example:
  • Resident Profile: Jane, a 70-year-old resident, is undergoing a 14-day PPS assessment.
  • Steps:
    1. Review Records: The nurse reviews Jane’s medical records, including the admission records and previous assessments.
    2. Identify Assessment Type: It is confirmed that Jane is undergoing a 14-day PPS assessment.
    3. Document and Code: The nurse documents the assessment type in Jane’s records and codes A0310B as "02".
  • Outcome: Jane’s 14-day PPS assessment is accurately documented and coded, ensuring proper record-keeping and compliance.

Please note that the information provided in this guide for MDS 3.0 Item set A0310B 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.