Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
Assessment (OBRA or Scheduled PPS), whichever is more
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
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Assessment (OBRA or Scheduled PPS), whichever is more
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Assessment (OBRA or Scheduled PPS), whichever is more recent (cont.) 6. The therapist had Resident S, who has Parkinson’s disease, stand on one foot during their therapy session to intentionally challenge the resident’s balance. Despite providing contact guard assistance and use of safety mats, Resident S fell and landed on their left side. An X- ray was ordered due to pain and swelling of the left wrist which confirmed a distal radius fracture of the left wrist.
Coding: J1800 would be coded 1, yes and J1900C would be coded 1, one.
Rationale: Despite safety precautions in place, Resident S sustained a radius fracture
as a result of a fall during a therapeutic intervention with physical therapy. This is a fall, as the clinician’s interventions did not intercept the loss of balance, and the resident landed on the floor and sustained a fracture, which is a major injury. Differentiating from Traumatic vs. Pathological Fractures
7. Resident A, who has osteoporosis, falls, resulting in a right hip fracture. The Emergency
Department physician confirms that the fracture is a result of the resident’s bone disease and not a result of the fall.
Coding: J1800 would be coded 1, yes and J1900C would be coded 0, none.
Rationale: The physician determined that the fracture was a pathological fracture due
to osteoporosis. Because the fracture was determined to be pathological, it is not coded as a fall with major injury.
8. Resident L, who has osteoporosis, falls, resulting in a right hip fracture. The physician in the
acute care hospital confirms that the fracture is a result of the resident’s fall and not the resident’s history of osteoporosis.
Coding: J1800 would be coded 1, yes and J1900C would be coded 1, one.
Rationale: Because the physician determined that the fracture was a result of the fall, it
is a traumatic fracture and, therefore, is a fall with major injury.