The MDS 3.0 includes a wide variety of ADL changes, ranging from revised coding requirements to specific modifications of certain ADL items. Although developing an understanding of the many changes may be a challenge, it is necessary to ensure correct coding of ADLs under the MDS 3.0, which plays an important role in facility reimbursement and the quality of care provided to the residents.
One of the more general changes to ADL coding under the MDS 3.0 is the requirement to complete the self-performance column before coding the support-provided column for item G0110. The MDS 2.0 does not specify that these columns must be completed in a certain order.
The MDS 3.0 also makes some changes to coding ADL self-performance. To code a resident as independent (0) under self-performance, the resident must have completed the activity with no help or oversight at any time during the seven-day look-back period. Under the MDS 2.0, you could code a resident as independent even if help or oversight was provided one or two times during the look-back period. In addition to the modification to the self-performance score for independent, the MDS 3.0 adds a new self-performance code of 7, which indicates that an activity occurred only once or twice during the look-back period. This code was not available on the MDS 2.0.
Another coding change included on the MDS 3.0 is that SNFs can only code support provided by facility staff members. Support provided by family members, other visitors, or people who are not facility employees cannot be counted in item G0110.
In addition to these coding changes, the MDS 3.0 includes changes to individual ADL items. Some of these items and explanations of the changes are as follows:
- Bed mobility (item G0110A). How a resident positions his or her body while in alternate sleep furniture is added to the definition for bed mobility.
- Eating (item G0110H). This ADL no longer includes eating or drinking during medication pass, and the only IV fluids that can be included are those administered for nutrition or hydration. Also, support provided for this ADL will count toward RUG classification; under the MDS 2.0, only a resident’s self-performance score for the eating ADL was considered in RUG classification.
- Toilet use (item G0110I). Under the MDS 3.0, the emptying of a bedpan, urinal, bedside commode, catheter bag, or ostomy bag should not be included in the toilet use ADL. This was not specified in the MDS 2.0.
- Balance during transitions and walking (item G0300). The MDS 2.0 only looked at a resident’s static balance, meaning his or her balance while standing and sitting. Under the MDS 3.0, SNF staff members have to code a resident’s balance while moving from a seated to standing position, walking, turning around, moving on and off the toilet, and transferring from surface to surface (such as between a bed and chair or wheelchair).
Another important change included in the MDS 3.0 is the adjustment of the ADL index, which went from four to 18 under the MDS 2.0 to zero to 16 under the MDS 3.0.The MDS 3.0 also standardizes the ADL ranges across certain categories in the RUG hierarchy and realigns the scoring so it is the same for the four late-loss ADLs: transfer, bed mobility, eating, and toilet use.