Understanding and Coding MDS 3.0 Item A1805: "Entered From"

Introduction

Purpose:

MDS 3.0 Item A1805, "Entered From," is a critical part of the resident admission process, capturing the source from which a resident was admitted or reentered into the long-term care facility. Proper documentation of this item helps provide context for the resident’s current condition and care needs. Accurate coding ensures that the resident's entry is correctly classified, which is essential for care planning and regulatory compliance.

What is MDS Item A1805?

Explanation:

MDS Item A1805 records the specific location or setting from which the resident was admitted or reentered the long-term care facility. This item helps identify whether the resident was admitted from another healthcare facility, their own home, or another setting. Knowing where the resident came from provides valuable information for care planning, particularly in understanding the resident’s recent medical history, potential care transitions, and any specific needs they may have upon entering the facility.

The potential sources from which a resident might enter include:

1. Community (Code 01): The resident was admitted from a private residence, including their own home, a family member's home, or an apartment.
2. Another nursing home or swing bed (Code 02): The resident was transferred from another nursing facility or a swing bed.
3. Acute hospital (Code 03): The resident was admitted directly from an acute care hospital.
4. Psychiatric hospital (Code 04): The resident entered from a psychiatric hospital.
5. Inpatient rehabilitation facility (IRF) (Code 05): The resident was admitted from an IRF.
6. Assisted living facility (Code 06): The resident entered from an assisted living facility.
7. Hospice (Code 07): The resident was admitted from a hospice care setting.
8. Long-term care hospital (LTCH) (Code 08): The resident entered from an LTCH.
9. Other (Code 09): The resident entered from another setting not specified above.

Guidelines for Coding A1805

Coding Instructions:

1. Identify the Source: Determine the exact location or setting from which the resident was admitted or reentered. This should be verified through admission records, discharge papers, or communication with the transferring facility.

2. Response Coding:

   • Code 01 for Community.
   • Code 02 for Another nursing home or swing bed.
   • Code 03 for Acute hospital.
   • Code 04 for Psychiatric hospital.
   • Code 05 for Inpatient rehabilitation facility (IRF).
   • Code 06 for Assisted living facility.
   • Code 07 for Hospice.
   • Code 08 for Long-term care hospital (LTCH).
   • Code 09 for Other.

3. Documentation: Ensure that the source of entry is clearly documented in the resident’s medical record, with supporting information that confirms the entry source, such as transfer paperwork or communication logs with the referring facility.

Example Scenario:

Mrs. Green was admitted to the long-term care facility directly from an acute hospital following surgery. For MDS Item A1805, this would be coded as 03 (Acute hospital).

Best Practices for Accurate Coding

Documentation:

• Maintain clear documentation that supports the source of the resident’s entry, ensuring that it matches the selected code in the MDS assessment. This might include hospital discharge summaries, transfer forms, or notes from communication with the referring facility.

Communication:

• Ensure effective communication between the admissions team and the facility from which the resident is being transferred. This helps confirm the correct entry source and provides valuable information for developing the resident’s initial care plan.

Training:

• Train staff on the importance of accurately identifying and coding the source of a resident’s entry. Emphasize how this information affects care planning and transitions of care, as well as regulatory reporting.

Conclusion

Summary:

Accurately coding MDS Item A1805 is essential for documenting where a resident was admitted from, which is critical for care planning and understanding the resident’s recent medical history. Proper documentation and communication ensure that the source of entry is correctly recorded, supporting effective care coordination and regulatory compliance.

Click here to see a detailed Step-by-Step on how to complete this item set.

Reference

This information is based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Page 2-10.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item A1805: "Entered From" was originally based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. 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.