Step-by-Step Coding Guide for Item Set N0350: Insulin

1. Review of Medical Records

Begin by meticulously reviewing the resident's medical records for any documentation of insulin use during the 7-day look-back period. Focus on physician orders, nursing notes, and medication administration records (MAR) to identify any instances where insulin was administered or prescribed.

2. Understanding Definitions

Insulin: A hormone used to manage and treat diabetes by controlling blood glucose levels. It may be delivered through injections or an insulin pump.

Regular Insulin: Short-acting insulin typically used around meal times to control blood sugar spikes.

Rapid-Acting Insulin: Very fast-acting insulin used to control blood sugar spikes during meals.

Intermediate-Acting Insulin: Insulin that starts working within a few hours and lasts for about half a day or longer, often used to control blood sugar overnight or between meals.

Long-Acting Insulin: Insulin that starts working several hours after injection and lasts for a full day or longer, used to maintain baseline insulin levels.

Insulin Pump: A device that delivers continuous insulin at set and variable rates.

3. Coding Instructions

For N0350, you will code each type of insulin separately based on its administration during the look-back period. This includes:

• N0350A: Regular Insulin
• N0350B: Rapid-acting Insulin
• N0350C: Intermediate-acting Insulin
• N0350D: Long-acting Insulin
• N0350E: Insulin Mixtures
• N0350Z: None of the Above

The coding for each sub-item is as follows:

• Code 0: Not used
• Code 1: Used in the last 7 days

4. Coding Tips

• Multiple Entries: If a resident receives more than one type of insulin, ensure each is accurately coded under the respective category.
• Insulin Pump: If using an insulin pump, code based on the type of insulin in the pump.
• Clarify Insulin Types: Ensure you understand the type of insulin to correctly categorize it under rapid, regular, intermediate, or long-acting.

5. Documentation

• Accuracy: Document the type and administration times of insulin in the medical records and MDS accurately.
• Changes: Note any changes in insulin type or dosage during the look-back period.

6. Common Errors to Avoid

• Misclassification: Ensure each insulin type is correctly classified to avoid coding errors.
• Overlooking PRN Insulin: Include PRN (as needed) insulin administrations in the coding.
• Failing to Review All Sources: Check all relevant medical documentation for complete information on insulin use.

7. Practical Application

Example Scenario: A resident with Type 2 diabetes receives 20 units of long-acting insulin at bedtime and uses a rapid-acting insulin pen before meals. During the 7-day look-back period, the resident used the rapid-acting insulin three times a day before meals.

• Coding:
  • N0350A (Regular Insulin): Code 0 (Not used)
  • N0350B (Rapid-acting Insulin): Code 1 (Used)
  • N0350C (Intermediate-acting Insulin): Code 0 (Not used)
  • N0350D (Long-acting Insulin): Code 1 (Used)
  • N0350E (Insulin Mixtures): Code 0 (Not used)

The Step-by-Step Coding Guide for item N0350 in MDS 3.0 Section N is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.