J0410: Pain Frequency

J0410: Pain Frequency

Steps for Assessment

1. Ask the resident: “How much of the time have you experienced pain or hurting over the last 5 days?” Staff may present response options on a written sheet or cue card. This can help the resident respond to the items.

2. If the resident provides a related response but does not use the provided response scale, help clarify the best response by echoing (repeating) the resident’s own comment and providing related response options. This interview approach frequently helps the resident clarify which response option they prefer.

3. If the resident, despite clarifying statement and repeating response options, continues to have difficulty selecting between two of the provided responses, then select the more frequent of the two.

Coding Instructions

Code for pain frequency over the last 5 days.

• Code 1, Rarely or not at all: if the resident responds “rarely” to the question.

• Code 2, Occasionally: if the resident responds “occasionally” to the question.

• Code 3, Frequently: if the resident responds “frequently” to the question.

• Code 4, Almost constantly: if the resident responds “almost constantly” to the question.

• Code 9, Unable to answer: if the resident is unable to respond, does not respond, or gives a nonsensical response.

Coding Tips

• No predetermined definitions are offered to the resident related to frequency of pain.

— The response should be based on the resident’s interpretation of the frequency options.

— Facility policy should provide standardized tools to use throughout the facility in assessing pain to ensure consistency in interpretation and documentation of the resident’s pain.

Examples

1. When asked about pain, Resident C responds, “All the time. It has been a terrible week. I have not been able to get comfortable for more than 10 minutes at a time since I started physical therapy four days ago.”

Coding: J0410 would be coded 4, Almost constantly.

Rationale: Resident C describes pain that has occurred “all the time.”

2. When asked about pain, Resident J responds, “I don’t know if it is frequent or occasional. My knee starts throbbing every time they move me from the bed or the wheelchair.”The interviewer says: “Your knee throbs every time they move you. If you had to choose an answer, would you say that you have pain frequently or occasionally?” Resident J is still unable to choose between frequently and occasionally.

Coding: J0410 would be coded 3, Frequently.

Rationale: The interviewer appropriately echoed Resident J’s comment and provided related response options to help them clarify which response they preferred. Resident J. remained unable to decide between frequently and occasionally. The interviewer therefore coded for the higher frequency of pain.

3. When asked about pain, Resident K responds: “I can’t remember. I think I had a headache a few times in the past couple of days, but they gave me acetaminophen and the headaches went away.” The interviewer clarifies by echoing what Resident K said: “You’ve had a headache a few times in the past couple of days and the headaches went away when you were given acetaminophen. If you had to choose from the answers, would you say you had pain occasionally or rarely?” Resident K replies “Occasionally.”

Coding: J0410 would be coded 2, Occasionally.

Rationale: After the interviewer clarified the resident’s choice using echoing, the resident selected a response option.

4. When asked about pain, Resident M responds, “I would say rarely. Since I started using the patch, I don’t have much pain at all, but four days ago the pain came back. I think they were a bit overdue in putting on the new patch, so I had some pain for a little while that day.”

Coding: J0410 would be coded 1, Rarely or not at all.

Rationale: Resident M selected the “Rarely or not at all” response option.