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DiraChart MDS item reference
J1550ZSection Jv1.20.1Manual page J-29
Problem conditions: none of the above
This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.
Quick coding
Answer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Check all that apply
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Not checked
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Item-specific instructions
Coding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
Steps for Assessment
1. Review the medical record, interview staff on all shifts and observe the resident for any
indication that the resident had vomiting, fever, potential signs of dehydration, or internal
bleeding during the 7-day look-back period.
Coding Instructions
Check all that apply (blue box)
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J1550A, fever
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J1550B, vomiting
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J1550C, dehydrated
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J1550D, internal bleeding
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J1550Z, none of the above
Coding Tips
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Fever: Fever is defined as a temperature 2.4 degrees F higher than baseline. The
resident’s baseline temperature should be established prior to the Assessment Reference
Date.
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Fever assessment prior to establishing base line temperature: A
temperature of 100.4 degrees F (38 degrees C) on admission (i.e., prior to the
establishment of the baseline temperature) would be considered a fever.
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Vomiting: Regurgitation of stomach contents; may be caused by many factors (e.g.,
drug toxicity, infection, psychogenic).
J1550: Problem Conditions (cont.)
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Dehydrated: Check this item if the resident presents with two or more of the following
potential indicators for dehydration:
1. Resident takes in less than the recommended 1,500 ml of fluids daily (water or
liquids in beverages and water in foods with high fluid content, such as gelatin and
soups). Note: The recommended intake level has been changed from 2,500 ml to
1,500 ml to reflect current practice standards.
2. Resident has one or more potential clinical signs (indicators) of dehydration,
including but not limited to dry mucous membranes, poor skin turgor, cracked
lips, thirst, sunken eyes, dark urine, new onset or increased confusion, fever, or
abnormal laboratory values (e.g., elevated hemoglobin and hematocrit, potassium
chloride, sodium, albumin, blood urea nitrogen, or urine specific gravity).
3. Resident’s fluid loss exceeds the amount of fluids they take in (e.g., loss from
vomiting, fever, diarrhea that exceeds fluid replacement).
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Internal Bleeding: Bleeding may be frank (such as bright red blood) or occult (such
as guaiac positive stools). Clinical indicators include black, tarry stools, vomiting “coffee
grounds,” hematuria (blood in urine), hemoptysis (coughing up blood), and severe
epistaxis (nosebleed) that requires packing. However, nose bleeds that are easily
controlled, menses, or a urinalysis that shows a small amount of red blood cells should
not be coded as internal bleeding.
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