Understanding and Coding MDS 3.0 Item E0100A: Psychosis - Hallucinations

Understanding and Coding MDS 3.0 Item E0100A: Psychosis - Hallucinations

Introduction

Purpose: Hallucinations, a symptom of psychosis, are serious mental health concerns in long-term care residents that require immediate attention. MDS Item E0100A focuses on identifying whether a resident has experienced hallucinations—seeing, hearing, or sensing things that are not present—over the past two weeks. Accurate coding of this item is crucial for recognizing mental health disorders such as schizophrenia, delirium, or dementia, and for ensuring proper interventions and support are provided to improve the resident’s quality of life.

What is MDS Item E0100A?

Explanation: MDS Item E0100A is part of Section E: Behavioral Symptoms. It asks whether the resident has experienced hallucinations during the past two weeks, as observed or reported by staff. Hallucinations can be visual, auditory, tactile, or olfactory, and they may signal serious mental health issues that require medical intervention. Identifying the presence of hallucinations is vital for assessing the resident’s mental health and ensuring that the care team provides timely interventions, such as medication management or psychiatric evaluation.

Guidelines for Coding MDS Item E0100A

Coding Instructions: To code MDS Item E0100A, staff must determine whether the resident has experienced hallucinations over the past two weeks. Hallucinations can include seeing or hearing things that are not there, feeling sensations without a physical cause, or smelling unusual odors that no one else detects. The coding is binary:

• 0 - No: The resident has not experienced hallucinations.
• 1 - Yes: The resident has experienced hallucinations.

Example Scenario: If a resident reports seeing people in their room who are not there or hears voices no one else can hear, and this has been observed or reported by staff during the past two weeks, you would code E0100A as 1 - Yes. If there have been no such reports or observations, the appropriate code would be 0 - No.

Best Practices for Accurate Coding

Observation and Communication: Staff should carefully observe the resident’s behavior, paying attention to any signs of hallucinations, such as talking to unseen people, responding to sounds that others do not hear, or reporting strange sensations. Residents may also express fear or confusion as a result of these experiences, which should be noted.

Documentation: Thorough documentation of hallucination episodes is critical. Record specific examples of the resident’s behavior, such as describing visions or sounds, and any context that may explain these experiences. This helps support the coding decision and informs the care plan.

Communication: If hallucinations are observed, share this information with the interdisciplinary care team immediately. This may involve discussing possible causes such as medication side effects, delirium, or underlying psychiatric conditions, and adjusting the resident’s care plan accordingly.

Training: Provide regular training for staff on recognizing hallucinations and differentiating them from delusions or other symptoms of mental health issues. This ensures that hallucinations are properly identified and coded, allowing for timely interventions.

Conclusion

Summary: MDS Item E0100A is critical for identifying residents who may be experiencing hallucinations, which can be signs of serious mental health issues. Accurate coding of this item based on staff observations ensures that these symptoms are recognized early, allowing for appropriate medical interventions that improve the resident’s mental health and quality of life.

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

Reference

This guide 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 E-5.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item E0100A: "Psychosis - Hallucinations" 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. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.