Long-Term Care

Coding Item E0100: Potential Indicators of Psychosis

MDS 3.0 Insider, March 21, 2011

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When coding potential indicators of psychosis in Item E0100 it can be difficult to determine if a behavior is actually considered a hallucination or delusion. To help ensure an accurate assessment of a resident’s psychological state, the RAI User’s Manual provides the following steps:

  1. Review the resident’s medical record for the 7-day look-back period.
  2. Interview staff members and others who have had the opportunity to observe the resident in a variety of situations during the 7-day look-back period.
  3. Observe the resident during conversations and the structured interviews in other assessment sections and listen for statements indicating an experience of hallucinations, or the expression of false beliefs (delusions).
  4. Clarify potentially false beliefs:
    -- When a resident expresses a belief that is plausible but alleged by others to be false (e.g., history indicates that the resident’s husband died 20 years ago, but the resident states her husband has been visiting her every day), try to verify the facts to determine whether there is reason to believe that it could have happened or whether it is likely that the belief is false.
    -- When a resident expresses a clearly false belief, determine if it can be readily corrected by a simple explanation of verifiable (real) facts (which may only require a simple reminder or reorientation) or demonstration of evidence to the contrary. Do not, however, challenge the resident.
    -- The resident’s response to the offering of a potential alternative explanation is often helpful in determining whether the false belief is held strongly enough to be considered fixed.

Code item E0100 based on behaviors observed and/or thoughts expressed in the last 7 days rather than the presence of a medical diagnosis. Check all that apply.

  • Check E0100A, hallucinations, if hallucinations were present in the last 7 days. A hallucination is the perception of the presence of something that is not actually there. It may be auditory or visual or involve smells, tastes or touch.
  • Check E0100B, delusions, if delusions were present in the last 7 days. A delusion is a fixed, false belief not shared by others that the resident holds true even in the face of evidence to the contrary.
  • Check E0100Z, none of the above, if no hallucinations or delusions were present in the last 7 days.

For more in-depth guidance on MDS 3.0 coding and processes, attend our MDS 3.0 Boot Camp. The MDS 3.0 Boot Camp is an intensive training program that focuses on accurate completion of the new MDS 3.0 assessment and links the assessment process to clinical standards of care, quality outcomes, and reimbursement.

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