Understanding and Coding MDS Item D0600: PHQ Staff Assessment - Total Mood Severity Score

MDS 3.0 Item D0600: PHQ Staff Assessment - Total Mood Severity Score

Introduction

Purpose: Assessing the overall mood severity of a resident is a critical part of identifying mental health concerns in long-term care settings. MDS Item D0600 focuses on calculating the total mood severity score based on the responses from the PHQ-9 Staff Mood Interview (items D0500A1 through D0500J2). This score helps quantify the severity of a resident’s depressive symptoms and guides appropriate interventions to improve their mental well-being.

What is MDS Item D0600?

Explanation: MDS Item D0600 is part of Section D: Mood, under the PHQ Staff Assessment for mood. It is used to calculate the total mood severity score by summing up the scores from individual PHQ-9 questions (D0500A1 to D0500J2). The total score ranges from 0 to 30, with higher scores indicating more severe depressive symptoms. This score is crucial for identifying the severity of mood disturbances, such as depression, and determining the appropriate level of care and support for the resident.

Guidelines for Coding MDS Item D0600

Coding Instructions: To code MDS Item D0600, you must sum the scores of the individual PHQ-9 items (D0500A1 through D0500J2) from the staff assessment. Each question on the PHQ-9 has a score based on the frequency of symptoms observed:

• 0 - Not at all: No symptoms observed.
• 1 - Several days: Symptoms observed on several days.
• 2 - More than half the days: Symptoms observed on more than half the days.
• 3 - Nearly every day: Symptoms observed nearly every day.

The total mood severity score is the sum of the individual scores, which can range from 0 (no depressive symptoms) to 30 (severe depressive symptoms).

Example Scenario: If a resident has shown low mood for several days (scored 1), expressed feelings of low self-worth nearly every day (scored 3), and experienced trouble sleeping on more than half the days (scored 2), the scores would be summed to give a total score of 6 for those three symptoms. The final total mood severity score for all PHQ-9 items is then calculated by adding the scores from all relevant questions.

Best Practices for Accurate Coding

Accuracy in Observation and Documentation: Ensure that all PHQ-9 items are properly assessed and documented. Consistent and accurate observations of mood symptoms are essential to capture the severity of depressive symptoms. It is important to involve staff members who interact regularly with the resident, as they can provide valuable insights.

Summing the Scores: Double-check the scores from individual items before summing them to ensure the final total mood severity score is accurate. Incorrect scoring can lead to an inaccurate assessment of the resident’s mood severity, affecting their care plan.

Use the Total Score to Guide Interventions: The total mood severity score should guide clinical decisions. Higher scores (e.g., 20 or above) may require urgent mental health interventions, such as counseling or medication. Lower scores may still warrant monitoring and support to prevent the worsening of symptoms.

Training: Provide regular training for staff on completing the PHQ-9 assessments, including how to accurately observe, score, and sum the individual items to determine the resident’s total mood severity score.

Conclusion

Summary: MDS Item D0600 is crucial for calculating the total mood severity score, which quantifies the resident’s depressive symptoms and informs the development of care plans. By accurately coding this item, staff can ensure that residents with mood disturbances receive timely and appropriate interventions that improve their 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 D-23.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0600: "PHQ Staff Assessment - Total Mood Severity Score" 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 item within MDS 3.0. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.