New guidance on coding ADLs on the MDS 3.0 March 24, 2013

Recently, CMS has clarified, and some would say, redefined, correct coding of ADLs in Section G0110 of the MDS 3.0.  A clarification and rewording of the ADL algorithm on page G-6 of the RAI manual in May is expected.  Here is the clarification:


Consider the following ADL coding scenario:

• Supervision (code of “1”) occurred three times,
• Limited Assistance  (code of “2”) occurred once,
• Extensive Assistance (code of “3”) occurred once, and
• Total Assistance (code of “4”) occurred once in the look back period.

 Because the threshold of three or more times of Supervision was met and there were not three or more instances of a single higher level, the correct code in such a scenario would be “1” indicating Supervision. According to the RAI User’s Manual, page G-4, “when an activity occurs at more than one level, but not three times at any one level, the provider should then apply the following:

• Episodes of full staff performance are considered to be weight-bearing assistance (when every episode is full staff performance—this is total dependence)
• When there are three or more episodes of a combination of full staff performance and weight-bearing assistance—code extensive assistance (3)
• When there are three or more episodes of a combination of full staff performance, weight-bearing assistance, and non-weight-bearing assistance—code limited assistance (2).”

Please note that these rules for combining various levels of support only occur when the “activity occurs at more than one level, but not three times at any one level.”