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Strategies to Achieve Accuracy in your ADL Coding

One of the most challenging documentation areas in the nursing home setting is Activities of Daily Living or ADL coding. There are many reasons for this; a vast number of staff members contribute to the documentation, the terminology can be confusing, many ADL’s have sub-sets of tasks that impact the coding level and staff members may under estimate how much they assist the patient.  

Factors to Consider: 

  • ADL score is a driver of both the Medicare and Case Mix rates
  • Does Staff have a clear understanding of the scoring definitions
  • Staff should document resident ADL at the end of their shifts to ensure that they are capturing the correct scores. Resident ADL capabilities change throughout the course of the day
  • Do you begin your ADL assessment on day of admission
  • Do you consider ADL scoring on a daily basis? Weekly in your UR/PPS meeting
  • Do you have a system in place to know when someone is on the border with their ADL score and go back to review the record, interview staff, review therapy notes, etc. to try to find support for the one extra point needed to capture the higher level
  • Is there a discussion around ADL scores among the interdisciplinary team to validate general accuracy
  • A lot can change within your assessment time frame, so make sure that you are capturing the best ADL score by choosing the best date 

A number of factors can have an impact ADL status:

  • Fatigue
  • Weakness
  • Acute illnesses
  • Exacerbation of chronic illnesses
  • Cognitive deficits
  • Medication effects
  • Behaviors such as resistance with care or agitation
  • Pain
  • Lack of motivation
  • Falls

ADL coding is a complex process that involves many staff members & has a significant impact on quality measures & reimbursement. It can be overwhelming if only one or two people are responsible for ensuring the accuracy of the documentation. Accurate ADL coding will result in better Quality Measures, can improve the 5 Star ranking & provides reimbursement for the care that is actually delivered. A comprehensive program utilizing the talents of many people can make your program successful.

Tags: nursing home operations