Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
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MDS Lookup
Pneumococcal Vaccine
Item Rationale
Matrix review
5 matrix group(s) are already attached for review on this item.
Answer coverage
4 governed answer row(s) are attached for this item.
Answer Codes
Code 0
No
if the resident’s pneumococcal vaccination status is not up to date or cannot be determined. Proceed to item O0300B, If Pneumococcal vaccin...
Code 1
Yes
if the resident’s pneumococcal vaccination status is up to date. Skip to O0350, Resident’s COVID-19 vaccination is up to date.
Code 2
Offered and declined
resident or responsible party/legal guardian has been informed of what is being offered and chooses not to accept the pneumococcal vaccine.
Code 3
Not offered
resident or responsible party/legal guardian not offered the pneumococcal vaccine.
What this item is
Item Rationale
When to use it
Use this item when the facility is completing content tied to Section O and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page O-15
- CMS exact locator: Manual page O-15
- This item has 4 governed answer row(s) attached.
Source awareness
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
Source & Review
Manual
CMS MDS 3.0 RAI Manual v1.20.1
Status
Published
Effective start
2025-10-01
Item locator
Manual page O-15
CMS exact locator
Manual page O-15
Full CMS Text
Item Rationale
Health-related Quality of Life
Pneumococcus is one of the leading causes of community-acquired infections in the United States, with the highest disease burden among the elderly. Adults 65 years of age and older and those with chronic medical conditions are at increased risk for invasive pneumococcal disease and have higher case-fatality rates. Pneumococcal vaccines can help reduce the risk of invasive pneumococcal disease and pneumonia.
Planning for Care
Early detection of outbreaks is essential to control outbreaks of pneumococcal disease in long-term care facilities. Individuals living in nursing homes and other long-term care facilities with an identified increased risk of invasive pneumococcal disease or its complications should receive pneumococcal vaccination. Conditions that increase the risk of invasive pneumococcal disease include decreased immune function; damaged or no spleen; sickle cell and other hemoglobinopathies; cerebrospinal fluid (CSF) leak; cochlear implants; and chronic diseases of the heart, lungs, liver, and kidneys, including dialysis, diabetes, alcoholism, and smoking. CDC guidance about risk conditions can be found at https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/risk-indications.html.
Steps for Assessment
1. Review the resident’s medical record to determine whether any pneumococcal vaccines have
been received. If vaccination status is unknown, proceed to the next step.
2. Ask the resident if they received any pneumococcal vaccines outside of the facility. If
vaccination status is still unknown, proceed to the next step.
3. If the resident is unable to answer, ask the same question of the responsible party/legal
guardian and/or primary care physician. If vaccination status is still unknown, proceed to the next step.
4. If pneumococcal vaccination status cannot be determined, administer the recommended
vaccine(s) to the resident, according to the standards of clinical practice. If the resident has had a severe allergic reaction to a pneumococcal vaccine or its components, the vaccine should not be administered. If the resident has a moderate to severe acute illness, the vaccine should be administered after the illness. If the resident has a minor illness (e.g., a cold) check with the resident’s physician before administering the vaccine. Coding Instructions O0300A, Is the Resident’s Pneumococcal Vaccination Up to Date?
Code 0, no: if the resident’s pneumococcal vaccination status is not up to date or
cannot be determined. Proceed to item O0300B, If Pneumococcal vaccine not received, state reason.
Code 1, yes: if the resident’s pneumococcal vaccination status is up to date. Skip to
O0350, Resident’s COVID-19 vaccination is up to date. Coding Instructions O0300B, If Pneumococcal Vaccine Not Received, State Reason If the resident has not received a pneumococcal vaccine, code the reason from the following list:
Code 1, Not eligible: if the resident is not eligible due to medical contraindications,
including a life-threatening allergic reaction to the pneumococcal vaccine or any vaccine component(s) or a physician order not to immunize.
Code 2, Offered and declined: resident or responsible party/legal guardian has
been informed of what is being offered and chooses not to accept the pneumococcal vaccine.
Code 3, Not offered: resident or responsible party/legal guardian not offered the
pneumococcal vaccine.
Coding Tips
Specific guidance about pneumococcal vaccine recommendations and timing for adults can be found at https://www.cdc.gov/pneumococcal/downloads/vaccine-timing-adults- jobaid.pdf. “Up to date” in item O0300A means in accordance with current Advisory Committee on Immunization Practices (ACIP) recommendations. For up-to-date information on timing and intervals between vaccines, please refer to ACIP vaccine recommendations available at — https://www.cdc.gov/vaccines/hcp/imz-schedules/ — https://www.cdc.gov/acip-recs/hcp/vaccine-specific/ — https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/ If a resident has received one or more pneumococcal vaccinations and is indicated to get an additional pneumococcal vaccination but is not yet eligible for the next vaccination because the recommended time interval between vaccines has not lapsed, O0300A is coded 1, yes, indicating the resident’s pneumococcal vaccination is up to date.
Examples
1. Resident L, who is 72 years old, received the PCV13 pneumococcal vaccine at their
physician’s office last year. They had previously been vaccinated with PPSV23 at age 66.
Coding: O0300A would be coded 1, yes; skip to O0350, Resident’s COVID-19
vaccination is up to date.
Rationale: Resident L, who is over 65 years old, has received the recommended
PCV13 and PPSV23 vaccines. Because it is not at least 5 years after the last pneumococcal vaccine, PCV20 or PCV21 are not considered by the physician at this time.
2. Resident B, who is 95 years old, has never received a pneumococcal vaccine. Their physician
has an order stating that they are NOT to be immunized.
Coding: O0300A would be coded 0, no; and O0300B would be coded 1, not
eligible.
Rationale: Resident B has never received the pneumococcal vaccine; therefore, their
vaccine is not up to date. Their physician has written an order for them not to receive a pneumococcal vaccine, thus they are not eligible for the vaccine.
3. Resident A, who has congestive heart failure, received PPSV23 vaccine at age 62 when they
were hospitalized for a broken hip. They are now 78 years old and were admitted to the nursing home one week ago for rehabilitation. They were offered and given PCV20 on admission.
Coding: O0300A would be coded 1, yes; skip to O0350, Resident’s COVID-19
vaccination is up to date.
Rationale: Resident A received PPSV23 before age 65 years because they have a
chronic heart disease. Because it was at least one year since Resident A received the PPSV23, the facility offered and administered PCV20.
4. Resident T, who has a long history of smoking cigarettes, received the PPSV23
pneumococcal vaccine at age 62 when they were living in a congregate care community. They are now 64 years old and are being admitted to the nursing home for chemotherapy and respite care. They have not been offered any additional pneumococcal vaccines.
Coding: O0300A would be coded 0, no; and O0300B would be coded 3, Not
offered.
Rationale: Resident T is not up to date with their pneumococcal vaccination and has
not been offered another vaccination to bring them up to date per current vaccination recommendations. Resident T received 1 dose of PPSV23 vaccine prior to 65 years of age because they are a smoker. Because Resident T is age 50 years or older and it is at least one year since they received the PPSV23 vaccine, they should receive one dose of PCV20 or PCV21 or one dose of PCV15. Their vaccines would then be complete.
Matrix Applicability
Nursing Home Subsets
NC - Comprehensive
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NQ - Quarterly
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
ND - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Swing Bed Subsets
SP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
SD - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Program and Policy Use
NHQI Quality Measures
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Stand Alone Assessments
OBRA Admission A=01, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Quarterly A=02, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Annual / Sig Chg A=03, B=99, F=99, G=^, H=0 A= 04, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Discharge A=99, B=99, F=10, 11, G=1, 2, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
D/C Items (Only when A0310F = 10 or 11)
A0310G=1 PDC
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
A0310G=2 UPD
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4