Step-by-Step Coding Guide for Item Set N0350B: Insulin: Orders for Insulin

1. Review of Medical Records

Objective: To accurately identify all orders for insulin, including changes in orders, during the 7-day look-back period.

• Key Points:
  • Thoroughly examine the resident's medical records for physician orders related to insulin. This includes initial orders, changes in dosage, and any stop orders.
  • Review medication administration records (MARs), pharmacy records, and communication logs for any documentation of insulin orders.

2. Understanding Definitions

Objective: Clarify what constitutes an order for insulin within the context of MDS coding.

• Key Points:
  • Orders for Insulin: Refers to any physician or authorized healthcare provider's written or electronic instruction to administer insulin to a resident. This includes new orders, adjustments to existing orders, and discontinuations.

3. Coding Instructions

Objective: Provide guidelines for accurately coding orders for insulin in the MDS.

• Key Points:
  • Code the total number of orders for insulin made during the 7-day look-back period in the N0350B item space.
  • Count each distinct order separately, including new orders, dosage changes, and discontinuations.

4. Coding Tips

Objective: Offer advice to ensure comprehensive and accurate coding of insulin orders.

• Key Points:
  • Pay special attention to any adjustments in insulin therapy, as even small dosage changes count as a new order.
  • Clarify with the pharmacy or prescribing provider if there is any ambiguity about whether a communication constitutes a new order.

5. Documentation

Objective: Emphasize the importance of thorough documentation for insulin orders.

• Key Points:
  • Ensure that each insulin order is clearly documented in the resident's medical record, including the type of insulin, dosage, administration times, and any special instructions.
  • Record the date and time each order was made to accurately count orders within the look-back period.

6. Common Errors to Avoid

Objective: Identify and prevent common mistakes in coding and documentation for N0350B.

• Key Points:
  • Not recognizing dosage changes or temporary holds as new orders.
  • Overlooking orders due to inadequate review of pharmacy or electronic health record communications.
  • Incorrectly counting the same order multiple times due to misinterpretation of documentation.

7. Practical Application

Objective: Apply N0350B coding instructions to a practical, illustrative scenario.

• Key Points:
  • Scenario: During the look-back period, a resident with type 2 diabetes had an insulin dosage increase, a temporary hold on insulin orders while undergoing surgery, and a subsequent order resuming insulin at the new dosage.
  • Coding: Code "3" in N0350B, reflecting one order for the dosage increase, one order for the temporary hold, and another order to resume insulin at the new dosage.
  • Follow-Up: Monitor the resident's response to changes in insulin therapy, documenting blood glucose levels, and adjust the care plan as necessary based on ongoing assessments and orders.

Please note that the information provided in this guide for MDS 3.0 Item set N0350B was originally based on the CMS's RAI Version 3.0 Manual, October 2023 edition. 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.