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Q: I've been told that any abnormal lab results in the previous 90 days need to be coded on the MDS in item P9. However, the MDS states to only code abnormal lab results since admission. Which is correct?

Julia's PPS Chat, May 25, 2005

Welcome once again to our PPS chat!

Sometimes the MDS coding rules can be difficult to understand-even when you use the revised Resident Assessment Instrument (RAI) User's Manual to answer your coding questions.

Read on to find out the answer to a question about coding lab results-

Q: I've been told that any abnormal lab results in the previous 90 days need to be coded on the MDS in item P9. However, the MDS states to only code abnormal lab results since admission. Which is correct?

A:Let's refer to the revised RAI User's Manual definition for this answer.

Page 3-206 states that this item indicates "whether the resident had any abnormal laboratory values during the last 90 days or since admission to the nursing facility. This item refers only to laboratory tests performed after admission to the nursing facility."

If a resident has been at your nursing home more than 90 days, consider lab values in the 90 days prior to and including the assessment reference date. If a resident has been at the nursing home less than 90 days, only look back to the admission date. Do not include any lab results prior to admission.

In order to determine whether a lab result is abnormal, compare it to the standard identified normal values, even if the abnormal result is intended or desired. The RAI User's Manual gives an example of an elevated prothrombin time in a resident receiving Coumadin.

This is the intended result of the medication-however, if the level is higher than the standard normal values, the result is considered abnormal.

Be sure that you follow these guidelines carefully when coding abnormal lab values. You want any abnormal values to be accurately reflected on your MDS; however, you don't want to include any laboratory results that would be considered normal.

We'll be chatting again soon-