N0350: Insulin

N0350: Insulin

Item Rationale

Health-related Quality of Life

Insulin is a medication used to treat diabetes mellitus (DM).

Individualized meal plans should be created with the resident’s input to ensure appropriate meal intake. Residents are more likely to be compliant with their DM diet if they have input related to food choices.

Planning for Care

Orders for insulin may have to change depending on the resident’s condition (e.g., fever or other illness) and/or laboratory results.

Ensure that dosage and time of injections take into account meals, activity, etc., based on individualized resident assessment.

Monitor for adverse effects of insulin injections (e.g., hypoglycemia).

Monitor HbA1c and blood glucose levels to ensure appropriate amounts of insulin are being administered.

Steps for Assessment

Review the resident’s medication administration records for the 7-day look-back period (or since admission/entry or reentry if less than 7 days).

Determine if the resident received insulin injections during the look-back period.

Determine if the physician (or nurse practitioner, physician assistant, or clinical nurse specialist if allowable under state licensure laws) changed the resident’s insulin orders during the look-back period.

Count the number of days insulin injections were received and/or insulin orders changed.

Coding Instructions for N0350A

Enter in Item N0350A, the number of days during the 7-day look-back period (or since admission/entry or reentry if less than 7 days) that insulin injections were received.

Coding Instructions for N0350B

Enter in Item N0350B, the number of days during the 7-day look-back period (or since admission/entry or reentry if less than 7 days) that the physician (nurse practitioner, physician assistant, or clinical nurse specialist if allowable under state licensure laws) changed the resident’s insulin orders.

Coding Tips and Special Populations

For sliding scale orders:

A sliding scale dosage schedule that is written to cover different dosages depending on lab values does not count as an order change simply because a different dose is administered based on the sliding scale guidelines.

If the sliding scale order is new, discontinued, or is the first sliding scale order for the resident, these days can be counted and coded.

For subcutaneous insulin pumps, code only the number of days that the resident actually required a subcutaneous injection to restart the pump.