Understanding and Coding MDS Item E0100Z: Psychosis - None of the Above

MDS 3.0 Item E0100Z: Psychosis - None of the Above

Introduction

Purpose: Psychotic symptoms, such as hallucinations and delusions, are serious mental health issues that can affect the quality of life of long-term care residents. MDS Item E0100Z is used to indicate that a resident has not experienced either of the psychotic symptoms—hallucinations (E0100A) or delusions (E0100B)—over the past two weeks. Accurate coding of this item confirms the absence of these symptoms and helps in ensuring that the resident’s mental health is monitored consistently.

What is MDS Item E0100Z?

Explanation: MDS Item E0100Z is part of Section E: Behavioral Symptoms, under the psychosis assessment. This item is selected when the resident has not exhibited any signs of psychosis, specifically hallucinations or delusions, during the past two weeks. If neither E0100A (hallucinations) nor E0100B (delusions) are marked as “Yes,” Item E0100Z should be coded to confirm the absence of psychotic symptoms. Coding this item helps ensure a complete and accurate picture of the resident’s mental health.

Guidelines for Coding MDS Item E0100Z

Coding Instructions: To code MDS Item E0100Z, staff must ensure that neither hallucinations nor delusions were observed or reported for the resident over the past two weeks. If the resident has not shown any signs of these psychotic symptoms, you should code:

• 0 - No: This should be coded if hallucinations or delusions (E0100A or E0100B) were marked as "Yes."
• 1 - Yes: Code 1 - Yes if neither hallucinations nor delusions were observed or reported.

Example Scenario: If a resident has not experienced hallucinations (E0100A) or delusions (E0100B) during the past two weeks, and both were coded as "No," you would code E0100Z as 1 - Yes. If either hallucinations or delusions were observed, E0100Z would not be coded, as one of the earlier items (E0100A or E0100B) would take precedence.

Best Practices for Accurate Coding

Confirming Absence of Symptoms: Before coding E0100Z, ensure that no hallucinations or delusions have been reported or observed over the two-week assessment period. If either of the symptoms has been present, E0100Z should not be coded.

Documentation: While no specific behavior needs to be documented for coding E0100Z, ensuring accurate records of staff observations regarding hallucinations or delusions (or lack thereof) is essential. Proper documentation helps confirm the resident’s mental status.

Communication: Discuss the resident’s mental health status with the interdisciplinary care team to confirm the absence of psychotic symptoms. This collaborative approach ensures that all members of the care team are aware of the resident’s mental health and can monitor for any changes.

Training: Provide regular training for staff to help them differentiate between psychotic symptoms such as hallucinations or delusions and other mental health or cognitive issues. This ensures accurate coding and better resident care.

Conclusion

Summary: MDS Item E0100Z is used to confirm the absence of psychotic symptoms, specifically hallucinations and delusions, in a resident. Accurately coding this item based on staff observations ensures that the resident’s mental health is thoroughly assessed and any changes in their behavior are noted.

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 E-5.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item E0100Z: "Psychosis - None of the Above" 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. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.