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Q: I heard that the definition for coding dehydration on the MDS, item J1c, has changed. Is that correct-or should I still use the MDS form description of output exceeds input as my definition?

Julia's PPS Chat, August 3, 2005

Welcome again to our PPS chat!

Your job is probably never the same each day. Different things come up during the day that you have to deal with, and how you do your job changes, too. Just when you think you completely understand the coding of the MDS, here come more changes.

Read on to find out about one of them-

Q: I heard that the definition for coding dehydration on the MDS, item J1c, has changed. Is that correct-or should I still use the MDS form description of output exceeds input as my definition?

A: Not only does the revised Resident Assessment Instrument (RAI) User's Manual published in December 2002 contain a change in the definition of dehydration on p. 3-138, but the revisions published in June 2005 provide further clarification.

In order for you to check dehydration on the MDS, two of the following three indicators must be present within the seven-day assessment period:

  • The resident takes in less than 1,500 ml of fluid per day
  • The resident has one or more clinical signs of dehydration
  • The resident's fluid loss is greater than the amount of fluids the resident takes in

The major change in this definition is the recommended amount of fluids per day. You'll note that the above definition specifies 1,500 ml of fluid-this was changed from 2,500 ml of fluid in the old RAI User's Manual.

Additionally, the new manual gives examples of clinical signs of dehydration. These are listed as "dry mucous membranes, poor skin turgor, cracked lips, thirst, sunken eyes, dark urine, new onset or increased confusion, fever, abnormal laboratory values (e.g., elevated hemoglobin and hematocrit, potassium chloride, sodium albumin, blood urea nitrogen, or urine specific gravity)."

Therefore, use this new definition of dehydration when completing your MDS. Be sure to carefully assess each resident for the above three indicators and only check item J1c if at least two are present during your assessment period. Because dehydration is a sentinel event in the quality indicators and can affect PPS reimbursement, it's very important to code this item correctly.

So, be sure to follow the coding guidelines exactly as they are written in the revised manual and the published clarifications. Then you will be more aware of any changes to coding instructions.

Until we chat again about more coding questions on the MDS-