A1250Y: Transportation - Resident declines to respond, Step-by-Step

Step-by-Step Coding Guide for A1250Y: Transportation – "Resident declines to respond"

1. Review of Medical Records

Objective: Confirm that the resident declines to respond to questions about transportation and access to medical appointments.

Actions:

• Begin by asking the resident whether transportation has kept them from medical appointments or obtaining medications over the past six months to a year.
• If the resident explicitly declines to answer, code as A1250Y: Resident declines to respond.
• Do not proceed to gather information from family members, caregivers, or medical records once the resident has declined.

2. Understanding Definitions

A1250Y: Resident declines to respond indicates that the resident has refused to answer the questions regarding transportation challenges, either for medical or non-medical appointments.

Example Scenario:

• Resident A: When asked if transportation barriers kept them from medical appointments, the resident states, “I don’t want to answer.” This would be coded as A1250Y.

3. Coding Instructions

Step-by-Step:

• Step 1: Ask the resident if they have experienced transportation issues that kept them from medical appointments or obtaining medications.
• Step 2: If the resident declines to answer, code A1250Y.
• Step 3: Avoid seeking additional information from other sources once the resident declines to respond.

4. Coding Tips

• Avoid Overriding the Resident’s Decline: If the resident declines, do not attempt to gather this information from family members or medical records.
• Record Only the Decline: Code Y as the only response when the resident declines to provide information.

5. Documentation

Objective: Accurately document the resident’s choice not to respond to transportation-related questions.

Actions:

• Record the resident’s explicit refusal to respond in the medical record.
• Ensure that the resident’s refusal is not overridden by other sources of information, such as family members or legal representatives.

6. Common Errors to Avoid

• Asking Family After Refusal: Once the resident declines, do not ask family members or review medical records for this information.
• Assumptions: Do not assume reasons for the resident's refusal. Simply document that they declined.

7. Practical Application

Example 1:
A resident responds, “I don’t want to talk about it,” when asked about transportation barriers. This should be coded as A1250Y: Resident declines to respond.

Example 2:
A resident refuses to answer but a family member later mentions transportation issues. Still, the correct code is A1250Y, as the resident’s refusal cannot be overridden.

Please note that the information provided in this guide for MDS 3.0 Item set A1250Y 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.