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How Does the Breath They Take Affect the MDS 3.0?

By Pam West

Most people take breathing for granted. It's second nature, an involuntary reflex. But for the thousands of Americans who suffer from breathing problems, each breath is a major accomplishment. Those people include residents with chronic lung problems, such as asthma.

The majority of residents with chronic lung problems will receive treatment from a respiratory therapist under the direction of a physician. While the MDS 3.0 does not have a section relating specifically to respiratory conditions, Section O does address the special respiratory treatments, procedures and programs that have been delivered to the resident in the last 14 days.

Section O: Special Treatments, Procedures, and Programs

The treatments, procedures and programs listed in Item O0100, Special Treatments, Procedures, and Programs, can have a profound effect on an individual's health status, self-image, dignity and quality of life.

This section of the MDS addresses oxygen therapy, suctioning, tracheostomy care, ventilator or respirator usage and bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) treatments and procedures. It's important to accurately code this area, so let's review the relevant definitions as they appear in Section O of the MDS 3.0. Please refer to Section O for specific coding guidance.

Oxygen therapy is continuous or intermittent oxygen administered via a mask, cannula, etc. It is delivered to a resident to relieve hypoxia, including if oxygen was used in BiPAP/CPAP.1

A ventilator or respirator is any type of electrically or pneumatically powered closed-system mechanical ventilator support device that ensures adequate ventilation for the resident who is, or who might become, unable to support his or her own respiration.1

BiPAP and CPAP respiratory support devices prevent the airways from closing by delivering slightly pressurized air through a mask continuously or via electronic cycling throughout the breathing cycle. The BiPAP/CPAP mask enables the individual to support his or her own respiration by providing enough pressure when the individual inhales to keep his or her airways open, unlike ventilators that "breathe" for the individual.

Respiratory therapy is defined as "services that are provided by a qualified professional (such as respiratory therapists and respiratory nurses). Respiratory therapy services are for the assessment, treatment and monitoring of residents with deficiencies or abnormalities of pulmonary function. Respiratory therapy services include coughing, deep breathing, heated nebulizers, aerosol treatments, assessing breath sounds and mechanical ventilation, etc., which must be provided by a respiratory therapist or trained respiratory nurse."2 This does not include hand-held medication dispensers.

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