Understanding and Coding MDS Item I0020 – Indicate the Resident’s Primary Medical Condition Category

Introduction

Accurately documenting a resident’s primary medical condition is vital for care planning and reimbursement. MDS Item I0020 captures the primary condition category responsible for the resident’s stay in the facility, ensuring that the care team can provide the appropriate interventions and therapies.

What is MDS Item I0020?

MDS Item I0020 requires care providers to identify the resident’s primary medical condition category. This category reflects the condition that most impacts the resident’s stay and overall care needs. Examples include conditions such as stroke, fractures, or medically complex conditions like diabetes and chronic kidney disease.

Guidelines for Coding I0020

• Code 01-13: Select the code that best represents the resident’s primary medical condition, based on medical records and clinical documentation.
• ICD-10 Code: Enter the International Classification of Diseases (ICD) code that corresponds to the resident’s primary medical condition.

Instructions:

• Review the resident’s medical history, transfer documents, discharge summaries, and physician progress notes to determine the primary medical condition.
• Once the condition is identified, select the appropriate code from the MDS manual and enter the corresponding ICD-10 code in I0020B.

Example Scenario:

Resident B is admitted to the SNF for rehabilitation following a stroke. The physician's diagnosis is stroke, and the ICD-10 code is I69.051. Code 01 for stroke in I0020 and enter the ICD-10 code I69.051 in I0020B.

Best Practices for Accurate Coding

• Documentation: Ensure the primary medical condition is clearly documented in the resident’s records, including physician notes and discharge summaries.
• Communication: Collaborate with the healthcare team to ensure the primary condition is accurately reflected in the care plan.
• Training: Provide staff with training on selecting the correct ICD codes and understanding the primary medical condition categories.

Conclusion

Coding MDS Item I0020 ensures accurate documentation of a resident’s primary medical condition, helping guide care plans and supporting Medicare Part A reimbursement processes.

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

Reference:

CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Chapter 3, Page I-4.

Disclaimer:

Please note that the information provided in this guide for MDS 3.0 Item I0020 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.