E0200B: Verbal Behavioral Symptoms Directed Toward Others, Step-by-Step

Step-by-Step Coding Guide for Item Set E0200B: Verbal Behavioral Symptoms Directed Toward Others

1. Review of Medical Records

• Objective: To determine if the resident has exhibited verbal behavioral symptoms directed toward others, such as yelling, cursing, or threats.
• Process:
  • Behavioral Reports: Review detailed behavioral incident reports and nursing notes that document instances of verbal aggression or hostile interactions.
  • Psychological Evaluations: Examine notes from psychological assessments or behavioral health evaluations that discuss the resident’s verbal behaviors.
  • Interdisciplinary Team Notes: Check records from care planning meetings and interdisciplinary team discussions that address the resident’s verbal behaviors and interventions.

2. Understanding Definitions

• Verbal Behavioral Symptoms Directed Toward Others: This refers to verbal actions by the resident intended to harm, intimidate, or disturb others. Examples include yelling, cursing, making threats, or using offensive language directed at other residents, staff, or visitors.

3. Coding Instructions

• Code E0200B:
  • 0: No, the resident did not exhibit verbal behavioral symptoms directed toward others.
  • 1: Yes, the resident exhibited verbal behavioral symptoms directed toward others.
• Example: If a resident is documented as frequently yelling and cursing at staff or other residents, code E0200B as '1'.

4. Coding Tips

• Consistency: Ensure that observations and reports from multiple staff members and different times of day are considered to get a consistent picture of the resident’s behavior.
• Specificity: Clearly differentiate between general agitation or verbal expressions of frustration and direct verbal aggression aimed at others.

5. Documentation

• Required Documentation:
  • Incident Reports: Detailed descriptions of incidents including the context, specific verbal actions, and any responses from staff or other residents.
  • Care Planning Notes: Records of discussions and interventions planned or implemented to address the verbal behaviors.
  • Behavioral Logs: Regular entries that track the frequency, intensity, and context of the verbal behaviors.
• Example: A documentation entry might read: "On 05/10/2024, resident yelled and cursed at nursing staff during medication administration. Intervention: Staff provided reassurance and redirected the resident to a calming activity. Incident discussed in care team meeting on 05/11/2024."

6. Common Errors to Avoid

• Misclassification: Not distinguishing between occasional outbursts due to acute conditions (e.g., pain) and consistent verbal aggression.
• Incomplete Documentation: Failing to document the specific details of the verbal behaviors and the responses or interventions by the staff.
• Lack of Follow-Up: Not updating care plans and documentation when new behaviors are observed or when interventions are modified.

7. Practical Application

• Scenario: A resident with a history of dementia becomes verbally aggressive, often yelling and making threats during personal care activities. Nursing staff document these behaviors in the resident’s daily log and report them in the electronic health record. During a care team meeting, it is noted that the resident’s verbal aggression has increased, and a behavioral intervention plan is developed. The staff is trained on de-escalation techniques specific to this resident. Based on the documented incidents and ongoing observations, E0200B is coded as '1', indicating the presence of verbal behavioral symptoms directed toward others.

Please note that the information provided in this guide for MDS 3.0 Item set E0200B  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.