Ask Proactive – What types of services are included in the coding of Respiratory Therapy on the MDS? Can this be done by CMTs? What must be included in the documentation to code Respiratory Therapy?

Q:

What types of services are included in the coding of Respiratory Therapy on the MDS? Can this be done by CMTs? What must be included in the documentation to code Respiratory Therapy?

Appendix A of the RAI manual defines Respiratory Therapy as “Services that are provided by a qualified professional” which includes respiratory therapists and a respiratory nurse. “Respiratory therapy services are for the assessment, treatment, and monitoring of patients with deficiencies or abnormalities of pulmonary function”.

Respiratory therapy services would include the following:

• Coughing and deep breathing,
• Nebulizer treatments,
• Assessing breath sounds,
• And mechanical ventilation, etc.

 

The Appendix A definition also indicates these services “must be provided by a respiratory therapist or trained respiratory nurse”.  As respiratory therapy services include assessment “of patients with deficiencies or abnormalities of pulmonary function” this would not include a CMT as it is not within their scope of practice to assess.  The Respiratory Nurse providing these services “must be proficient in the modalities listed above either through formal nursing or specific training and may deliver these modalities as allowed under the state Nurse Practice Act and under applicable state laws”.

 

Documentation for Respiratory therapy must meet the following criteria as outlined in Section O of the RAI Manual:

• There must be a physician order for the therapy;
• The physician’s order must include a statement of frequency, duration, and scope of treatment;
• The services must be directly and specifically related to an active written treatment plan that is based on an initial evaluation performed by qualified personnel; (this evaluation requirement is often overlooked by facilities)
• The services are required and provided by qualified personnel; and
• The services must be reasonable and necessary for treatment of the resident’s condition.

 

Please note that only the minutes that the respiratory therapist or respiratory nurse actually spend with the resident may count towards the 15 minutes per day on one or more days when coding the MDS. This time includes resident evaluation/assessment, treatment administration and monitoring, and setup and removal of treatment equipment.

 

Time that a resident self-administers a nebulizer treatment without supervision of the respiratory therapist or respiratory nurse is not included in the minutes recorded on the MDS.   You also DO NOT include administration of metered-dose and/or dry powder inhalers in respiratory minutes.

 

Contact Proactive for Clinical Nurse Consulting services.

 

 

 

 

Written By:

 

 

 

Janine Lehman, RN, RAC-CT, CLNC

Director of Clinical Services

Proactive LTC Consulting