Understanding and Coding MDS 3.0 Item C0900Z: Staff Assessment of Mental Status - None of the Above Recalled

Understanding and Coding MDS 3.0 Item C0900Z: Staff Assessment of Mental Status - None of the Above Recalled

Introduction

Purpose:
MDS 3.0 Item C0900Z is a critical aspect of the cognitive assessment process in long-term care settings. This item is used to document when a resident is unable to recall any of the specific orientation questions assessed in previous items, such as the current season, location of their room, names/faces of staff, or the fact that they are in a nursing home. Accurate coding of this item helps identify significant cognitive impairment, guiding the development of targeted care plans to support the resident’s cognitive and emotional well-being.

What is MDS Item C0900Z?

Explanation:
MDS Item C0900Z, "Staff Assessment of Mental Status: None of the Above Recalled," is part of Section C, which focuses on cognitive patterns. This item is selected when a resident is unable to recall any of the orientation questions asked in previous related items (C0900A through C0900D). These items assess the resident’s ability to recall the current season, the location of their room, staff names and faces, and the fact that they are in a nursing home.

If the resident cannot recall any of these critical aspects of their environment, it suggests a severe level of cognitive impairment, such as advanced dementia or significant disorientation, requiring immediate and comprehensive intervention.

Guidelines for Coding C0900Z

Coding Instructions:
Item C0900Z should be coded when the resident fails to recall all the orientation details assessed in the prior items (C0900A-C0900D). This means that the resident was unable to accurately recall:

• The current season (C0900A),
• The location of their room (C0900B),
• The names or faces of staff members (C0900C),
• And the fact that they are in a nursing home (C0900D).

1. Code 1 - None of the Above Recalled: Select this option if the resident is unable to recall any of the above-mentioned orientation details.

Example Scenario:
If Mr. Davis is unable to correctly identify the current season, locate his room, recognize staff members, or recall that he is in a nursing home, Item C0900Z should be coded as "1 - None of the Above Recalled." This indicates that Mr. Davis is significantly disoriented and likely experiencing severe cognitive impairment.

Best Practices for Accurate Coding

Documentation:

• Detailed Observations: Document the resident’s responses to each of the orientation questions (C0900A-C0900D) to clearly support the decision to code Item C0900Z. Include specific notes on the resident’s level of confusion or disorientation.
• Consistency: Conduct regular assessments to monitor any changes in the resident’s cognitive status, particularly if they are coded under Item C0900Z, as this reflects a high level of cognitive concern.
• Objective Evidence: Use documented interactions to support the coding of C0900Z, ensuring that it reflects a consistent and accurate assessment of the resident’s cognitive function.

Communication:

• Interdisciplinary Team: Share the results of the cognitive assessment, including the coding of C0900Z, with the interdisciplinary care team. This information is crucial for developing an urgent and comprehensive care plan that addresses severe cognitive impairment.
• Family Involvement: Involve the resident’s family in discussions about the resident’s cognitive status, as this level of impairment may require significant changes to care plans and family expectations.

Training:

• Staff Education: Train staff on recognizing severe cognitive impairment and accurately assessing when a resident fails to recall critical orientation details. This training should emphasize the importance of thorough documentation and timely communication of findings.
• Assessment Techniques: Provide ongoing training on effective cognitive assessment techniques, particularly for residents with advanced cognitive decline who may be unable to participate in standard interviews or assessments.
• Updates and Refresher Courses: Keep staff updated on MDS guidelines and offer refresher courses to maintain high standards in cognitive assessment and care planning.

Conclusion

Summary:
Accurately coding MDS Item C0900Z is essential for identifying residents with severe cognitive impairment who are unable to recall basic orientation details. This assessment is critical for developing urgent and targeted care plans that address significant cognitive and emotional needs. By adhering to the coding guidelines and best practices, healthcare professionals can ensure comprehensive and accurate cognitive assessments, leading to better care outcomes for residents in long-term care settings.

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

Reference

Please refer to CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, specifically Chapter 3, Page C-11, for detailed instructions on coding Item C0900Z.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item C0900Z: Staff Assessment of Mental Status - None of the Above Recalled 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.