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Q: Our social worker is responsible for completing MDS Section E1, indicators of depression, anxiety, and sad mood. How will her responses in this section affect our Resource Utilization Group (RUG) rate?

Julia's PPS Chat, June 22, 2005

Welcome once again to our PPS chat!

Sometimes coding depression on the MDS can be, well, depressing. You want to code this portion of the MDS correctly, but how do you know you are right-and what impact does this coding have on PPS reimbursement?

Read on to find out the answer to these questions-

Q: Our social worker is responsible for completing MDS Section E1, indicators of depression, anxiety, and sad mood. How will her responses in this section affect our Resource Utilization Group (RUG) rate?

A:The coding in Section E1 will affect RUG rates for residents who classify into the clinically complex RUG categories. This section contains six different RUGs-CA1, CA2, CB1, CB2, CC1, and CC2. You'll note that three of these RUGs end with a "1" and three end with a "2." Based upon the activities of daily living score, a resident is classified into a RUG ending with either a "1" or a "2."

The RUGs that end with a "2" include signs of depression and are reimbursed at a higher rate than the corresponding RUGs that end with a "1." You will receive this higher reimbursement rate if you code at least three of the 16 indicators listed in Section E1 as either a "1" or a "2."

The observation period for this section is 30 days-not the usual seven-day lookback period. Therefore, include all depressive indicators for the 30 days ending with your assessment reference period.

If an indicator is present up to five days per week, code this item as a "1." If the frequency is six to seven days per week during your observation period, code it as a "2." If not present at all, then code it as a "0."

Be sure to carefully follow the updated Resident Assessment Instrument User's Manual directions for coding depression and remember how this area of the MDS can affect your Medicare reimbursement. Code this area correctly and you might even improve your mood!

We'll be chatting again soon-