RAI Manual v1.20.1Coding Instructions
for A0310, Type of Assessment
Enter the code corresponding to the reason or reasons for completing this assessment.
If the assessment is being completed for both Omnibus Budget Reconciliation Act (OBRA)–
required clinical reasons (A0310A) and Prospective Payment System (PPS) reasons (A0310B),
all requirements for both types of assessments must be met. See Chapter 2, Section 2.10,
Combining PPS Assessments and OBRA Assessments, for details of these requirements.
Assessments completed for other reasons (e.g., to facilitate billing for Medicare Advantage
Plans) are not coded in A0310 and are not submitted to iQIES.
Coding Instructions for A0310A, Federal OBRA Reason for
Assessment
•
Document the reason for completing the assessment, using the categories of assessment
types. For detailed information on the requirements for scheduling and timing of the
assessments, see Chapter 2 on assessment schedules.
•
Enter the number corresponding to the OBRA reason for assessment. This item contains
2 digits. For codes 01-06, enter “0” in the first box and place the correct number in the
second box. If the assessment is not coded 01-06, enter code “99”.
01. Admission assessment (required by day 14)
02. Quarterly review assessment
03. Annual assessment
04. Significant change in status assessment
05. Significant correction to prior comprehensive assessment
06. Significant correction to prior quarterly assessment
99. None of the above
Manual page A-4RAI Manual v1.20.1Coding Tips
and Special Populations
•
If a nursing home resident elects the hospice benefit, the nursing home is required to
complete an MDS Significant Change in Status Assessment (SCSA). The nursing home
is required to complete an SCSA when the resident comes off the hospice benefit
(revoke). See Chapter 2 for details on this requirement.
•
It is a CMS requirement to have an SCSA completed EVERY time the hospice benefit
has been elected, even if a recent MDS was done and the only change is the election of
the hospice benefit.
A0310: Type of Assessment (cont.)
Coding Instructions for A0310B, PPS
Assessment
•
Enter the number corresponding to the PPS reason for
completing this assessment. This item contains 2 digits.
For codes 01 and 08, enter “0” in the first box and place
the correct number in the second box. If the assessment
is not coded as 01 or 08, enter code “99.”
•
See Chapter 2 on assessment schedules for detailed
information on the timing of the assessments.
PPS Scheduled Assessment for Medicare Part A Stay
01. 5-day scheduled assessment
PPS Unscheduled Assessment for Medicare Part A Stay
08. IPA-Interim Payment Assessment
Not PPS Assessment
99. None of the above
Coding Instructions for A0310E, Is This Assessment the First
Assessment (OBRA, Scheduled PPS, or OBRA Discharge) since
the Most Recent Admission/Entry or Reentry?
•
Code 0, no: if this assessment is not the first of these assessments since the most recent
admission/entry or reentry.
•
Code 1, yes: if this assessment is the first of these assessments since the most recent
admission/entry or reentry.
Coding Tips and Special Populations
•
A0310E = 0 for:
o Entry or Death in Facility tracking records (A0310F = 01 or 12);
o A standalone Part A PPS Discharge assessment (A0310A = 99, A0310B = 99,
A0310F = 99, and A0310H = 1); or
o An Interim Payment Assessment (A0310A = 99, A0310B = 08, A0310F = 99, and
A0310H=0).
•
A0310E = 1 on the first OBRA, Scheduled PPS or OBRA Discharge assessment that is
completed and submitted once a facility obtains CMS certification. Note: the first
submitted assessment may not be an OBRA Admission assessment.
DEFINITION
PROSPECTIVE
PAYMENT SYSTEM
(PPS)
Method of reimbursement in
which Medicare payment is
made based on the
classification system of that
service.
A0310: Type of Assessment (cont.)
Coding Instructions for A0310F, Federal OBRA & PPS
Entry/Discharge Reporting
•
Enter the number corresponding to the reason for
completing this assessment or tracking record. This
item contains 2 digits. For code 01, enter “0” in the first
box and place “1” in the second box. If the assessment
is not coded as “01” or “10 or “11” or “12,” enter “99”:
01. Entry tracking record
10. Discharge assessment-return not anticipated
11. Discharge assessment-return anticipated
12. Death in facility tracking record
99. None of the above
Coding Instructions for A0310G, Type of
Discharge (complete only if A0310F = 10
or 11)
•
Enter the number corresponding to the type of
discharge.
•
Code 1: if type of discharge is a planned discharge.
•
Code 2: if type of discharge is an unplanned
discharge.
DEFINITION
Part A PPS Discharge
Assessment
A discharge assessment
developed to inform current
and future Skilled Nursing
Facility Quality Reporting
Program (SNF QRP)
measures and the calculation
of these measures. The
Part A PPS Discharge
assessment is completed
when a resident’s Medicare
Part A stay ends, but the
resident remains in the
facility; and must be
combined with an OBRA
Discharge if the Part A stay
ends on the same day or the
day before the resident’s
Discharge Date (A2000).
A0310: Type of Assessment (cont.)
Coding Instructions for A0310G1, Is this a
SNF Part A Interrupted Stay?
•
Code 0, no: if the resident was discharged from SNF
care (i.e., from a Medicare Part A-covered stay) but did
not resume SNF care in the same SNF within the
interruption window.
•
Code 1, yes: if the resident was discharged from
SNF care (i.e., from a Medicare Part A-covered stay)
but did resume SNF care in the same SNF within the
interruption window.
Coding Tips
•
Item A0310G1 indicates whether or not an interrupted
stay occurred.
•
The interrupted stay policy applies to residents who
either leave the SNF, then return to the same SNF
within the interruption window, or to residents who are
discharged from Part A-covered services and remain in
the SNF, but then resume a Part A-covered stay within
the interruption window.
DEFINITIONS
Interrupted Stay
Is a Medicare Part A SNF
stay in which a resident is
discharged from SNF care
(i.e., the resident is
discharged from a Medicare
Part A-covered stay) and
subsequently resumes SNF
care in the same SNF for a
Medicare Part A-covered
stay during the interruption
window.
Interruption Window
Is a 3-day period, starting
with the calendar day of Part
A discharge and including
the 2 immediately following
calendar days. In other
words, if a resident in a
Medicare Part A SNF stay is
discharged from Part A, the
resident must resume Part A
services, or return to the
same SNF (if physically
discharged) to resume Part A
services, by 11:59 p.m. at the
end of the third calendar day
after their Part A-covered
stay ended. The interruption
window begins with the first
non-covered day following a
Part A-covered stay and
ends at 11:59 p.m. on the
third consecutive non-
covered day following a Part
A-covered SNF stay. If these
conditions are met, the
subsequent stay is
considered a continuation of
the previous Medicare Part
A-covered stay for the
purposes of both the variable
per diem schedule and PPS
assessment completion.
A0310: Type of Assessment (cont.)
•
The following is a list of
Manual page A-4