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Q: Where on the MDS would I code a continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) machine used for sleep apnea? Can I count it as a ventilator or respirator?

Julia's PPS Chat, August 17, 2005

Welcome once again to our PPS chat!

You probably always have questions about coding accurately when completing the MDS. For instance, how should you code devices that are similar to ventilators or respirators?

Read on to find out the answer to these questions-

Q: Where on the MDS would I code a continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) machine used for sleep apnea? Can I count it as a ventilator or respirator?

A: The updated Resident Assessment Instrument (RAI) User's Manual provides specific directions regarding the coding of a CPAP or BIPAP device. Page 3-183 states that you should not code a BIPAP or CPAP in item P1l, ventilator or respirator. Further clarification of the reason why is stated on p. 3-184.

The manual states, "Residents with sleep apnea may undergo treatments with a mask-like device that is being used to keep the airway open during sleep. This service cannot be coded as a ventilator or a respirator . . . The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open."

The manual goes on to state that the level of intensity of services with CPAP or BIPAP devices does not equal that of ventilators or respirators. However, you should definitely include the use of a CPAP or BIPAP device in the resident's overall careplan, and provide appropriate nursing care.

Depending upon the resident's condition, you might want to check item J5a, conditions/diseases make resident's cognitive, activities of daily living, mood, or behavior patterns unstable. Or you might code item J5b, resident experiencing an acute episode or a flare-up of a recurrent or chronic problem. Both of these items would indicate that a greater level of nursing observation and intervention is required.

Once again, always follow the guidelines in the RAI User's Manual. If you have a question about coding a specific item, check the manual and the revisions that have been published and you might find the assistance you need to help with your coding.

We'll be chatting again soon about using grace days-