RAI Manual v1.20.1Steps for Assessment
1. Complete only if A0310H (Is this a SNF Part A PPS Discharge Assessment?) = 1, Yes.
2. Review the resident’s medical record (e.g., rehabilitation therapy evaluation and treatment
records, recreation therapy notes, mental health professional progress notes), and consult
with each of the qualified care providers to collect the information required for this item.
NOTE: The look-back period for these items is the entire SNF Part A stay, starting at Day 1
of the Part A stay and finishing on the last day of the Part A stay. Once reported on the MDS,
CMS grouping software will calculate the percentage of group and concurrent therapy,
combined, provided to each resident as a percentage of all therapies provided to that resident,
by discipline. If the combined amount of group and concurrent therapy provided, by
discipline, exceeds 25 percent, then this would be deemed as non-compliance and a warning
message would be received on the Final Validation Report.
Providers should follow the steps outlined below for calculating compliance with the
concurrent/group therapy limit:
•
Step 1: Total Therapy Minutes, by discipline (O0425X1 + O0425X2 + O0425X3)
•
Step 2: Total Concurrent and Group Therapy Minutes, by discipline (O0425X2 +
O0425X3)
•
Step 3: Concurrent/Group Ratio (Step 2 result/Step 1 result)
•
Step 4: If Step 3 result is greater than 0.25, then the provider is non-compliant.
O0425: Part A Therapies (cont.)
Manual page O-35RAI Manual v1.20.1Coding Instructions
for Speech-Language Pathology and Audiology
Services and Occupational and Physical Therapies
•
Individual minutes—Enter the total number of minutes of therapy that were provided on
an individual basis during the entire Part A stay (i.e., from the date in A2400B through
the date in A2400C). Enter 0 if none were provided. Individual services are provided by
one therapist or assistant to one resident at a time. (For detailed definitions and
Manual page O-35RAI Manual v1.20.1Coding Tips
and Special Populations
•
For detailed descriptions of how to code minutes of therapy and explanation of skilled
versus nonskilled therapy services, co-treatment, therapy aides and students, please refer
to these topic headings in the discussion of item O0390 above.
Modes of Therapy
A resident may receive therapy via different modes during the same day or even treatment
session. These modes are individual, concurrent and group therapy. When developing the plan of
care, the therapist and assistant must determine which mode(s) of therapy and the amount of time
the resident receives for each mode and code the MDS appropriately. The therapist and assistant
should document the reason a specific mode of therapy was chosen as well as anticipated goals
for that mode of therapy. For any therapy that does not meet one of the therapy mode definitions
below, those minutes may not be counted on the MDS. The therapy mode definitions must
always be followed and apply regardless of when the therapy is provided in relationship to all
assessment windows (i.e., applies whether or not the resident is in a look-back period for an
MDS assessment).
Individual Therapy
For a detailed definition and example of individual therapy, please refer to the discussion of item
O0390 above.
O0425: Part A Therapies (cont.)
Concurrent Therapy
For a detailed definition and example of concurrent therapy, please refer to the discussion of item
O0390 above.
Group Therapy
For a detailed definition and example of group therapy, please refer to the discussion of item
O0390 above.
Therapy Modalities
For a detailed definition and explanation of therapy modalities, please refer to the discussion of
item O0390 above.
General Coding Example:
Following a bilateral knee replacement, Resident G was admitted to the skilled nursing facility in
stable condition for rehabilitation therapy on Sunday 10/06/19 under Part A skilled nursing
facility coverage. While in the hospital, they exhibited some short-term memory difficulties
specifically affecting orientation. They were non-weight bearing, had reduced range of motion,
and had difficulty with ADLs. They were referred to SLP, OT, and PT with the long-term goal of
returning home with their spouse. Their initial SLP evaluation was performed on 10/06/19, and
the OT and PT initial evaluations were done on 10/07/19. They were also referred to recreational
therapy. They were in the SNF for 14 days and were discharged home on 10/19/2019. Resident
G received the following rehabilitation services during their stay in the SNF.
Speech-language pathology services that were provided over the SNF stay:
•
Individual cognitive training; six sessions for 45 minutes each day.
•
Discharged from SLP services on 10/14/2019.
Coding: O0425A1 would be coded 270; O0425A2 would be coded 0; O0425A3
would be coded 0; O0425A4 would be coded 0; O0425A5 would be coded 6.
Rationale: Individual minutes totaled 270 over the stay (45 minutes × 6
days); concurrent minutes totaled 0 over the stay (0 × 0 = 0); and group minutes totaled 0
over the stay (0 × 0 = 0). Therapy was provided 6 days of the stay.
Occupational therapy services that were provided over the SNF stay:
•
Individual ADL activities daily for 30 minutes each starting 10/08/19.
•
Co-treatment: seating and transferring with PT; three sessions for the following times: 23
minutes, 18 minutes, and 12 minutes.
•
Balance/coordination activities: 10 sessions for 20 minutes each session in a group.
O0425: Part A Therapies (cont.)
•
Discharged from OT services on 10/19/19.
Coding: O0425B1 would be coded 413, O0425B2 would be coded 0, O0425B3
would be coded 200, O0425B4 would be coded 53, O0425B5 would be coded 12.
Rationale: Individual minutes (including 53 co-treatment minutes) totaled 413 over the
stay [(30 × 12) + 53 = 413]; concurrent minutes totaled 0 over the stay (0 × 0 = 0); and
group minutes totaled 200 over the stay (20 × 10 = 200). Therapy was provided 12 days
of the stay.
Physical therapy services that were provided over the stay:
•
Individual mobility training daily for 45 minutes per session starting 10/07/19.
•
Group mobility training for 30 minutes Tuesdays, Wednesdays, and Fridays.
•
Co-treatment seating and transferring for three sessions with OT for 7 minutes, 22
minutes, and 18 minutes.
•
Concurrent therapeutic exercises Monday-Friday for 20 minutes each day.
•
Discharged from PT services on 10/19/19.
Coding: O0425C1 would be coded 632, O0425C2 would be coded 200, O0425C3
would be coded 180, O0425C4 would be coded 47, O0425C5 would be coded 13.
Rationale: Individual minutes (including 47 co-treatment minutes) totaled 632 over
stay [(45 × 13) + (7 + 22 + 18) = 632]; concurrent minutes totaled 200 over the stay
(20 × 10 = 200); and group minutes totaled 180 over the stay (30 × 6 = 180). Therapy
was provided 13 days of the stay.
Manual page O-35