Understanding and Coding MDS Item D0150H2: PHQ Resident Interview - Slow, Fidgety, Restless (Frequency)

Understanding and Coding MDS Item D0150H2: PHQ Resident Interview - Slow, Fidgety, Restless (Frequency)

Introduction

Purpose:
MDS Item D0150H2, "PHQ Resident Interview: Slow, Fidgety, Restless - Frequency," is part of the Patient Health Questionnaire (PHQ-9) in the MDS 3.0 assessment, which is used to evaluate symptoms of depression and related psychomotor changes in residents. This item specifically assesses how frequently the resident has experienced psychomotor symptoms such as feeling unusually slow, fidgety, or restless over the past two weeks. Accurate coding of this item ensures that residents experiencing frequent psychomotor symptoms receive appropriate mental health interventions.

What is MDS Item D0150H2?

Explanation:
MDS Item D0150H2 is part of Section D (Mood) in the MDS 3.0, specifically under the PHQ-9 Resident Mood Interview. The PHQ-9 includes questions on depressive symptoms that often present with psychomotor changes like slowed movements, fidgetiness, or restlessness. These symptoms can impact a resident’s ability to engage in daily activities and signal underlying mental health concerns such as depression or anxiety.

For Item D0150H2, the resident is asked to report the frequency of these symptoms over the past two weeks. Their response helps the healthcare team understand the severity of the symptom, providing insight into the resident's mental state and supporting individualized care.

• Relevance: The frequency of psychomotor changes can indicate the depth of depressive symptoms. Regular monitoring of these symptoms allows for early interventions, helping to improve residents' quality of life.
• Importance: Properly coding D0150H2 ensures the care team has an accurate understanding of the resident’s mental health, facilitating timely and appropriate support.

Guidelines for Coding MDS Item D0150H2

Coding Instructions:

1. Ask the Resident About the Frequency of Psychomotor Changes:
   During the PHQ-9 interview, ask the resident the following question:
   “Over the last two weeks, how often have you felt fidgety, restless, or found yourself moving or speaking more slowly than usual?”

2. Scoring the Frequency of Psychomotor Symptoms:

   • Code 0 (Never) if the resident reports they have not experienced these symptoms at all in the past two weeks.
   • Code 1 (1–2 days) if the resident reports experiencing these symptoms on several days over the past two weeks.
   • Code 2 (3–4 days) if the resident reports experiencing these symptoms on more than half of the days in the past two weeks.
   • Code 3 (5–7 days) if the resident reports experiencing these symptoms nearly every day over the past two weeks.

3. Documentation Requirements:
   Record the resident’s response accurately in the MDS under Item D0150H2. Ensure the frequency documented reflects the resident’s self-report to avoid any discrepancies in their record.

4. Verification:
   Cross-check with any behavioral notes or observations from the care team if necessary. If the resident’s response is unclear, consider asking follow-up questions to confirm the frequency of symptoms.

Example Scenario:
Mrs. Taylor reports feeling fidgety and restless nearly every day over the past two weeks. In this case, code 3 (5–7 days) for D0150H2, reflecting the high frequency of her symptoms.

Best Practices for Accurate Coding

Provide a Comfortable Interview Setting:
Conduct the interview in a quiet, private environment where the resident feels comfortable sharing personal experiences. This supportive environment encourages honesty and accuracy in responses.

Consistent Interview Approach:
Ask the question neutrally and empathetically, allowing the resident time to consider their response. Avoid leading or suggesting responses to ensure an accurate assessment of symptom frequency.

Staff Training on PHQ-9 Interview Techniques:
Train staff on administering the PHQ-9 and recognizing symptoms of psychomotor changes, including how to interpret responses related to frequency. Staff should be skilled at asking clear, non-leading questions to capture the resident’s experiences authentically.

Conclusion

MDS Item D0150H2 is crucial for assessing the frequency of psychomotor symptoms such as fidgetiness, restlessness, and slowness, which are indicative of depression or anxiety. Proper coding of this item supports mental health interventions by helping healthcare providers gauge the severity of the resident's symptoms, ensuring that residents with frequent psychomotor changes receive the care and support they need to improve their quality of life.

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

Reference

This guide is based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Page D-11.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0150H2: "PHQ Response - Frequency of Being Slow, Fidgety, or Restless" 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.