Step-by-Step Coding Guide for N0450. Antipsychotic Medication Review

1. Review of Medical Records:

• Start with a thorough review of the resident's medical records, including physician orders, nursing notes, and pharmacy records, focusing on the use of antipsychotic medications.
• Look for evidence of antipsychotic medication use during the 7-day look-back period.
• Identify if there was a gradual dose reduction (GDR) attempt in the last 90 days or if the resident was admitted less than 90 days ago but is receiving antipsychotic medication.

2. Understanding Definitions:

• Antipsychotic Medications: Drugs used to treat psychiatric conditions, specifically those related to psychosis, such as schizophrenia or bipolar disorder.
• Gradual Dose Reduction (GDR): A systematic process to reduce or discontinue antipsychotic medications when possible, to minimize potential adverse effects while managing psychiatric symptoms effectively.

3. Coding Instructions:

• N0450A: Code if a GDR was attempted in the last 90 days for a resident receiving antipsychotic medications. Code "1" for Yes, and "0" for No.
• N0450B: If no GDR was attempted, code the reason: clinical contraindication (1), resident or family refusal (2), or other reasons (3).

4. Coding Tips:

• Ensure accurate tracking of medication administration records to identify any changes in antipsychotic medication use.
• Consult with the prescribing physician or psychiatrist to verify the rationale for continuing, discontinuing, or altering the dosage of antipsychotic medications.
• Review interdisciplinary team notes for discussions about the resident's behavioral and psychological symptoms and their management.

5. Documentation:

• Document the reasons for initiating or continuing antipsychotic medication, including specific symptoms being treated.
• Record any attempts at GDR, including outcomes and any adverse effects noted.
• Ensure that resident or family refusals of GDR are well documented, including the rationale behind the refusal.

6. Common Errors to Avoid:

• Failing to document a GDR attempt or the rationale for not attempting a GDR.
• Incorrectly coding the use of antipsychotic medication when it is not present.
• Overlooking the need for periodic review and reassessment of antipsychotic medication necessity and dosage.

7. Practical Application:

• Example: A resident has been on an antipsychotic medication for behavioral symptoms related to dementia. The interdisciplinary team, in consultation with the resident's physician, decides to attempt a GDR due to the resident's stable condition. The attempt is documented, including the outcome and any changes in behavior.

The Step-by-Step Coding Guide for item N0450 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.