Understanding and Coding MDS Item A1510A: Level II PASRR Conditions - Serious Mental Illness

Introduction

Purpose:
MDS Item A1510A, "Level II PASRR Conditions: Serious Mental Illness," is used to document whether a resident has been identified as having a serious mental illness (SMI) under the Pre-Admission Screening and Resident Review (PASRR) Level II process. PASRR is a federally mandated program designed to ensure that individuals with mental illness, intellectual disabilities, or related conditions are appropriately placed in nursing facilities and receive the care and specialized services they need. Accurate documentation of a resident’s mental health condition in this item ensures proper care planning and access to appropriate behavioral health services.

What is MDS Item A1510A?

Explanation:
MDS Item A1510A is part of Section A, which captures identification information about the resident. This specific item focuses on whether a resident has been identified through the Level II PASRR evaluation as having a serious mental illness (SMI). The PASRR process helps ensure that residents with significant mental health conditions receive necessary services and are appropriately placed in long-term care facilities.

Serious Mental Illness (SMI) is defined by PASRR as a mental disorder that includes:

• A diagnosis such as schizophrenia, bipolar disorder, or major depressive disorder.
• Functional impairments that interfere with daily life activities.
• A recent history of psychiatric treatment or an episode of decompensation requiring intervention.

Residents with SMI may require specialized care or support, such as psychiatric services, medication management, and behavioral health interventions.

• Relevance: Identifying a resident with a serious mental illness through PASRR ensures that the nursing facility can develop an individualized care plan that addresses both medical and psychiatric needs.
• Importance: Proper coding of A1510A ensures that residents with serious mental illness are recognized in the MDS assessment, facilitating access to specialized behavioral health services and appropriate care interventions.

Guidelines for Coding MDS Item A1510A

Coding Instructions:

1. Review the PASRR Level II Evaluation:
   PASRR Level II evaluations are conducted before admission or at significant changes in condition. Review the resident’s Level II PASRR determination to confirm whether they have been identified as having a serious mental illness (SMI).

2. Answering A1510A:

   • Code 1 (Yes) if the resident’s PASRR Level II evaluation identifies them as having a serious mental illness.
   • Code 0 (No) if the resident does not have a serious mental illness as determined by the PASRR Level II process.

3. Documentation Requirements:
   Ensure that the PASRR Level II evaluation is included in the resident’s medical record and supports the coding of A1510A. The evaluation should specify the resident’s mental health diagnosis and any related services required.

4. Verification:
   Verify that the resident’s PASRR evaluation identifies a serious mental illness by cross-referencing with psychiatric records or behavioral health assessments.

Example Scenario:
Mr. Daniels, a 65-year-old resident with a diagnosis of schizophrenia, underwent a PASRR Level II evaluation prior to admission to the nursing facility. The evaluation confirmed that he has a serious mental illness requiring ongoing psychiatric support and medication management. In this case, code 1 (Yes) for A1510A.

Best Practices for Accurate Coding

Documentation:
Ensure that all PASRR Level II evaluations are well-documented in the resident’s medical record. This should include the psychiatric diagnosis, the need for specialized mental health services, and any recommendations for care.

Collaboration with Behavioral Health Services:
Work closely with the interdisciplinary team, including behavioral health professionals, to ensure that residents with serious mental illness receive appropriate services such as counseling, psychiatric care, and medication management.

Training:
Train staff on the importance of identifying and documenting serious mental illness in the MDS assessment. Staff should understand the PASRR process and the role it plays in ensuring that residents with significant mental health conditions receive the care they need.

Conclusion

MDS Item A1510A is critical for documenting whether a resident has been identified as having a serious mental illness (SMI) through the PASRR Level II evaluation. Accurate coding of this item ensures that residents with significant mental health needs are recognized in the MDS assessment, allowing for the development of appropriate care plans and access to specialized services. Proper documentation, collaboration with behavioral health providers, and staff training are essential to supporting residents with serious mental illness.

Click here to see a detailed step-by-step on how to complete this item set

Reference

For more detailed guidelines on coding MDS Item A1510A, refer to the CMS’s Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Chapter 3, Section A, Page 3-10.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item A1510A: "Level II PASRR Conditions: Serious Mental Illness" 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 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.