Q: What process should we follow to capture an accurate depression score and support the PDPM depression end split?
A:
Start the Resident Mood Interview early in the assessment window. The RAI Manual directs us to attempt the interview with all residents who are at least sometimes understood, regardless of their BIMS score. Use the resident’s preferred language and available communication supports, including hearing aids, glasses, writing, pointing, cue cards, sign language, or an interpreter when needed. Ask each question as written and code the resident’s actual response—not the diagnosis, medication list, or staff assumptions. After the first two PHQ questions, follow the MDS stop rules:
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- If both frequency responses are 0 or 1, end the PHQ-2 and total those two items.
- If both symptom-presence responses are 9, no response, leave the frequency items and total score blank.
- In all other situations, continue with the remaining PHQ-9 questions.
Do not substitute a staff assessment if the resident interview was refused, incomplete, or missed during the look-back period. The staff assessment is used only when B0100 is coded 0 because the resident is rarely or never understood, cannot communicate by another method, or a needed interpreter is unavailable. When staff assessment is appropriate, gather input from staff on all shifts who know the resident.
Common accuracy gaps include rushing the interview, failing to use communication supports, coding from a diagnosis alone, relying on one staff member’s observation, and not documenting follow-up. If the resident or staff member is between two frequency choices, code the higher frequency. If one question includes more than one symptom and the frequencies differ, code the highest frequency reported.
Significance of Accurate Depression Screening
Accurate depression screening supports resident-centered care and can affect the PDPM nursing classification. A resident meets the depression end-split criteria when the Resident Mood Interview Total Severity Score, D0160, is 10 or greater—excluding 99—or when the Staff Assessment Total Severity Score, D0600, is 10 or greater. Depression is used as a classification split within Special Care High, Special Care Low, and Clinically Complex nursing categories.
Before finalizing the MDS, ensure the score is supported by dated interview or observation documentation and communicate significant findings to the interdisciplinary team. Any statement involving self-harm or being better off dead requires immediate action according to facility policy, including nursing and provider notification, resident safety measures, and follow-up documentation.
Source: https://www.cms.gov/medicare/quality/nursing-home-improvement/resident-assessment-instrument-manual
Written By:
Sarah Becker, RN, RAC-CT, RAC-CTA, DNS-CT, QCP
Director of Clinical Reimbursement
Proactive LTC Consulting
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