The RAI Manual provides clear instruction on the coding of isolation. Documentation must support the medical necessity of isolation. Per the MDS 3.0 RAI User’s Manual, Isolation is coded only when:
- The resident requires transmission-based precautions AND
- Single room isolation (alone in a separate room) BECAUSE OF
- An active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) WITH
- Highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.
Do not code if:
- Resident only has a history of infectious disease (e.g., s/p MRSA or s/p C-Diff – no active symptoms).
- Precautions are standard precautions.
Code for “single room isolation” only when all of the following conditions are met:
- The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.
- Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.
CDC has also issued interim clinical guidance, including:
Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
Strategies to Optimize the Current Supply of N95 Respirators
Infection Prevention and Control Recommendations for Patients, including guidance on the use of personal protective equipment (PPE) during a shortage.
Blog by Kristen Walden, MSN, RN RAC-CT, Clinical Consultant, Proactive Medical Review
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