Cognition is a high-value skilled domain because a new change in mental status is one of the earliest and most treatable signs of an acute illness in an older adult — an infection, a medication effect, hypoxia, hypoglycemia, or dehydration often presents first as delirium. The skilled work is distinguishing a new, fluctuating delirium from the resident’s chronic dementia baseline, capturing the BIMS/CAM data the MDS requires, and acting on an acute change.
The purpose is to prove, for each billed day it applies, that skilled cognitive observation, management and evaluation, or teaching was reasonable, necessary, needed daily, and available only in a SNF under Pub. 100-02 Chapter 8. Cognitive assessment technique is the same as in home care; the coverage spine is re-pointed and the Section C linkage is added.
