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Q: I have a question about coding MDS item J5c, end-stage disease. How would I know if a resident has less than six months to live? Even our hospice residents sometimes live much longer than our expectations.

Julia's PPS Chat, April 13, 2005

Welcome again to our PPS chat!

It might appear to you that coding end-stage disease on the MDS is like trying to read what the future holds. What should you do when you don't know whether to code this item?

Read on to find out the answer-

Q: I have a question about coding MDS item J5c, end-stage disease. How would I know if a resident has less than six months to live? Even our hospice residents sometimes live much longer than our expectations.

A: First, let's look at the revised Resident Assessment Instrument (RAI) User's Manual definition of this item.

Page 3-147 of the manual defines end-stage disease as, "In one's best clinical judgment, the resident with any end-stage disease has only six or fewer months to live. This judgment should be substantiated by a well-documented disease diagnosis and deteriorating clinical course. A doctor's certification that the resident has six months or less to live must be present in the record before coding the resident as terminal on the MDS."

The intent of this item on the MDS is to identify whether a resident is deteriorating and therefore has terminal care needs. A resident who has a terminal condition with an expected six or fewer months to live has very different needs than a nonterminal resident. The terminal resident's care plan must reflect these needs accurately.

Therefore, code this item based upon your knowledge about the resident and the physician's prognosis. While you won't be able to tell the future, you can use your best judgment when coding end-stage disease.

Until we chat again about coding IV medications-