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If the resident has one day in a 7-day period that he is acutely ill and has a decrease in his level of consciousness and was not able to communicate, would that be coded as 3 rarely/never understood or should the complete seven days be taken into consideration?

Q: Regarding the ability to “make self understood and understanding others” (B0700, B0800), if the resident has one day in a 7-day period that he is acutely ill and has a decrease in his level of consciousness and was not able to communicate, would that be coded as 3 rarely/never understood or should the complete seven days be taken into consideration? The assessment is a discharge assessment and some think that the change in level of consciousness should be noted on the assessment somehow.

A: Although ADLs code the worst moment that happens three or more times, other items, such as ability to make self-understood, do not. It’s looking at the entire seven days, rather than the one unusual day. Your documentation should include the one day event, but your coding should look at all seven days.