E0300. Overall Presence of Behavioral Symptoms, Step-by-Step

Step-by-Step Coding Guide for Item Set E0300: Overall Presence of Behavioral Symptoms

1. Review of Medical Records

• Begin by reviewing the resident's medical records, including physician's notes, nursing notes, and behavioral assessments for any documentation of behavioral symptoms during the last 7 days. Look for specific descriptions of behaviors such as verbal aggression, physical aggression, other disruptive behaviors, and rejection of care.

2. Understanding Definitions

• Verbal Behavioral Symptoms Directed Toward Others: Includes threats, cursing, or other forms of verbal aggression.
• Physical Behavioral Symptoms Directed Toward Others: Involves hitting, biting, or other forms of physical aggression.
• Other Behavioral Symptoms Not Directed Toward Others: Such as pacing, rummaging, public sexual acts, or disrobing in public.
• Rejection of Care: Refusal or resistance to assistance with activities of daily living (ADLs) or other forms of care.

3. Coding Instructions

• Code 0 (Behavior not exhibited): Select this if the resident did not exhibit any of the behavioral symptoms listed during the last 7 days.
• Code 1 (Behavior of this type occurred): Choose this if the resident exhibited one or more of the behavioral symptoms during the last 7 days.

4. Coding Tips

• Ensure that behaviors are not attributed to an understandable cause, like pain, which might necessitate a different approach.
• Consult with a multidisciplinary team, including nursing staff, mental health professionals, and others who may have observed the resident's behavior.

5. Documentation

• Document specific instances of behavioral symptoms, including the date, time, circumstances, and staff responses. This information supports accurate coding and provides a basis for developing care plans.

6. Common Errors to Avoid

• Not reviewing all available documentation or consulting with various staff members, leading to missed instances of behavioral symptoms.
• Incorrectly coding behaviors that have an identifiable and justifiable cause, such as pain or environmental stressors.

7. Practical Application

• Example 1: A resident, usually calm, becomes verbally aggressive when in pain. After assessing and addressing the pain, if the aggression persists without any identifiable cause, code it as "1" for verbal behavioral symptoms directed toward others.
• Example 2: During assistance with morning care, a resident consistently swats at the caregiver. If this behavior occurred any day in the last 7 days without a justifiable reason, it should be coded as "1" under physical behavioral symptoms directed toward others.

The Step-by-Step Coding Guide for item E0300 in MDS 3.0 Section E is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.