Q:
Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because the resident’s previous BIMS scores have been 14 or15. When I interact with the resident, I don’t observe any cognitive decline, and the staff report no concerns either. Is this BIMS coding correct?
A:
No, the BIMS is incorrectly coded in this case. According to the RAI manual, most residents should be able to complete the BIMS (pg. C-1) and it should be attempted with all residents (pg. C-2). If a resident refuses, this may suggest cognitive decline (pg. C-15, example 1), and requires a change in approach to the interview.
First, it is important to assess whether the resident might be willing to complete the interview under different circumstances (e.g., at a different time of day or with a different interviewer). If the resident still refuses, the first four questions should be coded “0”, C0500 should be coded as “99” and the staff interview should be completed. Similarly, if the resident begins the BIMS but refuses or is unable to answer four or more questions, the situation should be handled the same as a complete refusal, and the staff interview should be conducted (pg. C-17).
Written by: Christopher Calo, RN, BSN, RAC-CTA
MDS Consultant
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