The Minimum Data Set (MDS) plays a crucial role in influencing facility reimbursement, quality measures, and overall care quality. The accuracy of MDS coding is paramount, relying heavily on precise assessments and interviews. Accuracy in assessing and screening for depression symptoms is critical for  care quality and reimbursement outcomes.

The MDS uses the PHQ-2 to 9 (resident interview) and the PHQ-9-OV (staff interview) to screen residents for depression symptoms. Incorporating the resident’s voice through direct interviews is a person-centered approach that can contribute significantly to the development of individualized care plans.  Interviews not only help in identifying specific symptoms, but also provide valuable insights into the resident’s unique experiences and preferences. Specific information gathered from direct resident interviews opens channels for identifying causes of depression and contributing factors.  This provides valuable insights that can lead to targeted interventions, including medical treatments, personal support, or modifications to care routines.  By addressing resident specific factors, healthcare providers can work towards improving the resident’s quality of life and overall outcomes.

Effective Interview Processes

Staff who are conducting interviews should follow guidance in Appendix D of the RAI, Interviewing to Increase Resident Voice in MDS Assessments. This guidance should be reviewed routinely, along with the Steps for Assessment for conducting the PHQ-2 to 9. Engage with the resident in their preferred language and ensure they have adequate hearing to participate in the interview, or access to their chosen communication method as necessary. If the resident appears unable to communicate, provide alternatives such as writing, pointing, sign language, or cue cards. Next, assess whether the resident is rarely or never understood verbally, in writing, or through another method. If communication challenges persist, proceed to Staff Assessment of Resident Mood (PHQ-9-OV©). If an interpreter is needed or desired, conduct the interview with the assistance of an interpreter.

Impact of MDS Coding Accuracy

Accurate coding of the PHQ-9 influences the nursing component of PDPM reimbursement. For residents in the Special Care High, Special Care Low, or Clinically Complex case mix groups, a total severity score of 10 or greater qualifies for the depression end-split. This seemingly small distinction translated to an average of $33 per day in fiscal year 2024 rates, showcasing the significance of accurate depression screening on reimbursement. Beyond payment considerations, the PHQ-2 to 9 allows you to identify and address risks early, enhancing overall resident well-being. The role of the Minimum Data Set (MDS) is undeniably pivotal, directly impacting facility reimbursement, quality measures, and the overall quality of care. The significance of accurate MDS coding, particularly in the context of depression screening, cannot be overstated. Effective application of the PHQ-2 to 9 and PHQ-9-OV for resident and staff interviews, respectively, not only ensures precision, but also fosters a person-centered approach.

Join Proactive beginning February 7, 2024 for the webinar series The Impact of the MDS, where Proactive’s MDS experts will provide clarity on crucial performance areas impacted by the RAI process, avoiding common errors and driving outcomes through MDS accuracy.




Brandy Hayes, RN, RAC-CT, RAC-CTA
Clinical Consultant

Was this article helpful? Access weekly insights when you sign up for our weekly newsletter!