Ask Proactive – One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met to discuss a primary diagnosis. Therapy insists we should use Z47.1 Aftercare following joint replacement surgery, but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture. Which is the correct code?

by | Dec 30, 2025 | Clinical, Coding, MDS, Medicare, PDPM, Reimbursement, SNF

Q: One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met to discuss a primary diagnosis. Therapy insists we should use Z47.1 Aftercare following joint replacement...

Ask Proactive – Can I code Malnutrition (Section I5600) on the MDS based on a dietary assessment that identifies the resident as at risk for malnutrition?

by | Dec 10, 2025 | Care Planning, Clinical, Coding, Dietary, Documentation, MDS, Medicaid, Medicare, Nursing, PDPM, Physicians

Q: Can I code Malnutrition (Section I5600) on the MDS based on a dietary assessment that identifies the resident as at risk for malnutrition?   A: No.  Dietitian assessments alone do not provide sufficient documentation for coding of this item on the MDS.  ...

Ask Proactive – I have recently been directed, when completing the PHQ-2 to 9, that if a resident acknowledges a symptom, but is unable to give a frequency, I should dash both questions (column 1 and 2). Is this correct?

by | Oct 1, 2025 | Coding, Compliance, Depression, MDS, Medicaid, Medicare, Nursing, PDPM, Reimbursement

Q: I have recently been directed, when completing the PHQ-2 to 9, that if a resident acknowledges a symptom, but is unable to give a frequency, I should dash both questions (column 1 and 2). Is this correct?   A: No, this is incorrect. If a resident answers “yes”...

Ask Proactive – When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?

by | Sep 17, 2025 | Admissions, Coding, Documentation, Education, MDS, Medicare, SNF, Webinars

Q: When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?   A: This question comes up often in SNFs. The primary diagnosis should be...