RAI Manual v1.20.1Steps for Assessment
1. Review the restorative nursing program notes and/or flow sheets in the medical record.
2. For the 7-day look-back period, enter the number of days on which the technique, training or
skill practice was performed for a total of at least 15 minutes during the 24-hour period.
3. The following criteria for restorative nursing programs must be met in order to code O0500:
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Measurable objective and interventions must be documented in the care plan and in the
medical record. If a restorative nursing program is in place when a care plan is being
revised, it is appropriate to reassess progress, goals, and duration/frequency as part of the
care planning process. Good clinical practice would indicate that the results of this
reassessment should be documented in the resident’s medical record.
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Evidence of periodic evaluation by the licensed nurse must be present in the resident’s
medical record. When not contraindicated by state practice act provisions, a progress note
written by the restorative aide and countersigned by a licensed nurse is sufficient to
document the restorative nursing program once the purpose and objectives of treatment
have been established.
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Nursing assistants/aides must be trained in the techniques that promote resident
involvement in the activity.
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A registered nurse or a licensed practical (vocational) nurse must supervise the activities
in a restorative nursing program. Sometimes, under licensed nurse supervision, other staff
and volunteers will be assigned to work with specific residents. Restorative nursing does
not require a physician’s order. Nursing homes may elect to have licensed rehabilitation
professionals perform repetitive exercises and other maintenance treatments or to
supervise aides performing these maintenance services. In situations where such services
do not actually require the involvement of a qualified therapist, the services may not be
coded as therapy in item O0390, Therapy Services, or O0425, Part A Therapies, because
the specific interventions are considered restorative nursing services (see items O0390,
Therapy Services, and O0425, Part A Therapies). The therapist’s time actually providing
the maintenance service can be included when counting restorative nursing minutes.
Although therapists may participate, members of the nursing staff are still responsible for
overall coordination and supervision of restorative nursing programs.
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This category does not include groups with more than four residents per supervising
helper or caregiver.
O0500: Restorative Nursing Programs (cont.)
Manual page O-43RAI Manual v1.20.1Coding Instructions
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This item does not include procedures or techniques carried out by or under the direction
of qualified therapists, as identified in Speech-Language Pathology and Audiology
Services item O0390A or O0425A, Occupational Therapy item O0390B or O0425B,
and Physical Therapy item O0390C or O0425C.
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The time provided for items O0500A–J must be coded separately, in time blocks of 15
minutes or more. For example, to check Technique—Range of Motion [Passive] item
O0500A, 15 or more minutes of passive range of motion (PROM) must have been
provided during a 24-hour period in the last 7 days. The 15 minutes of time in a day may
be totaled across 24 hours (e.g., 10 minutes on the day shift plus 5 minutes on the evening
shift). However, 15-minute time increments cannot be obtained by combining 5 minutes
of Technique—Range of Motion [Passive] item O0500A, 5 minutes of Technique—
Range of Motion [Active] item O0500B, and 5 minutes of Splint or Brace Assistance
item O0500C, over 2 days in the last 7 days.
•
Review for each activity throughout the 24-hour period. Enter 0, if none.
Technique
Activities provided by restorative nursing staff.
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O0500A, Range of Motion (Passive)
Code provision of passive movements in order to maintain flexibility and useful motion
in the joints of the body. These exercises must be individualized to the resident’s needs,
planned, monitored, evaluated and documented in the resident’s medical record.
•
O0500B, Range of Motion (Active)
Code exercises performed by the resident, with cueing, supervision, or physical assist by
staff that are individualized to the resident’s needs, planned, monitored, evaluated, and
documented in the resident’s medical record. Include active ROM and active-assisted
ROM.
•
O0500C, Splint or Brace Assistance
Code provision of (1) verbal and physical guidance and direction that teaches the resident
how to apply, manipulate, and care for a brace or splint; or (2) a scheduled program of
applying and removing a splint or brace. These sessions are individualized to the
resident’s needs, planned, monitored, evaluated, and documented in the resident’s
medical record.
O0500: Restorative Nursing Programs (cont.)
Training and Skill Practice
Activities including repetition, physical or verbal cueing, and/or task segmentation provided by
any staff member under the supervision of a licensed nurse.
•
O0500D, Bed Mobility
Code activities provided to improve or maintain the resident’s self-performance in
moving to and from a lying position, turning side to side and positioning themself in bed.
These activities are individualized to the resident’s needs, planned, monitored, evaluated,
and documented in the resident’s medical record.
•
O0500E, Transfer
Code activities provided to improve or maintain the resident’s self-performance in
moving between surfaces or planes either with or without assistive devices. These
activities are individualized to the resident’s needs, planned, monitored, evaluated, and
documented in the resident’s medical record.
•
O0500F, Walking
Code activities provided to improve or maintain the resident’s self-performance in
walking, with or without assistive devices. These activities are individualized to the
resident’s needs, planned, monitored, evaluated, and documented in the resident’s
medical record.
•
O0500G, Dressing and/or Grooming
Code activities provided to improve or maintain the resident’s self-performance in
dressing and undressing, bathing and washing, and performing other personal hygiene
tasks. These activities are individualized to the resident’s needs, planned, monitored,
evaluated, and documented in the resident’s medical record.
•
O0500H, Eating and/or Swallowing
Code activities provided to improve or maintain the resident’s self-performance in
feeding oneself food and fluids, or activities used to improve or maintain the resident’s
ability to ingest nutrition and hydration by mouth. These activities are individualized to
the resident’s needs, planned, monitored, evaluated, and documented in the resident’s
medical record.
•
O0500I, Amputation/ Prosthesis Care
Code activities provided to improve or maintain the resident’s self-performance in
putting on and removing a prosthesis, caring for the prosthesis, and providing appropriate
hygiene at the site where the prosthesis attaches to the body (e.g., leg stump or eye
socket). Dentures are not considered to be prostheses for coding this item. These
activities are individualized to the resident’s needs, planned, monitored, evaluated, and
documented in the resident’s medical record.
O0500: Restorative Nursing Programs (cont.)
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O0500J, Communication
Code activities provided to improve or maintain the resident’s self-performance in
functional communication skills or assisting the resident in using residual communication
skills and adaptive devices. These activities are individualized to the resident’s needs,
planned, monitored, evaluated, and documented in the resident’s medical record.
Manual page O-43RAI Manual v1.20.1Coding Tips
and Special Populations
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For range of motion (passive): the caregiver moves the body part around a fixed point or
joint through the resident’s available range of motion. The resident provides no
assistance.
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For range of motion (active): any participation by the resident in the ROM activity should
be coded here.
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For both active and passive range of motion: movement by a resident that is incidental to
dressing, bathing, etc., does not count as part of a formal restorative nursing program. For
inclusion in this section, active or passive range of motion must be a component of an
individualized program that is planned, monitored evaluated, and documented in the
resident’s medical record. Range of motion should be delivered by staff who are trained
in the procedures.
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For splint or brace assistance: assess the resident’s skin and circulation under the device,
and reposition the limb in correct alignment.
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The use of continuous passive motion (CPM) devices in a restorative nursing program is
coded when the following criteria are met: (1) ordered by a physician, (2) nursing staff
have been trained in technique (e.g., properly aligning resident’s limb in device, adjusting
available range of motion), and (3) monitoring of the device. Nursing staff should
document the application of the device and the effects on the resident. Do not include the
time the resident is receiving treatment in the device. Include only the actual time staff
were engaged in applying and monitoring the device.
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Remember that persons with dementia learn skills best through repetition that occurs
multiple times per day.
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Grooming programs, including programs to help residents learn to apply make-up, may
be considered restorative nursing programs when conducted by a member of the activity
staff. These grooming programs would need to be individualized to the resident’s needs,
planned, monitored, evaluated, and documented in the resident’s medical record.
O0500: Restorative Nursing Programs (cont.)
Manual page O-43