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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Should Brief Interview for Mental Status Be Conducted?
(cont.)
Matrix review
7 matrix group(s) are already attached for review on this item.
Answer coverage
2 governed answer row(s) are attached for this item.
Answer Codes
Code 0
No
if the interview should not be conducted because the resident is rarely/never understood; cannot respond verbally, in writing, or using ano...
Code 1
Yes
if the interview should be conducted because the resident is at least sometimes understood verbally, in writing, or using another method, a...
What this item is
(cont.)
When to use it
Use this item when the facility is completing content tied to Section C and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page C-2
- CMS exact locator: Manual page C-2
- This item has 2 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 C-2
CMS exact locator
Manual page C-2
Full CMS Text
Coding Instructions
Code 0, no: if the interview should not be conducted because the resident is
rarely/never understood; cannot respond verbally, in writing, or using another method; or an interpreter is needed but not available.
Code 1, yes: if the interview should be conducted because the resident is at least
sometimes understood verbally, in writing, or using another method, and if an interpreter is needed, one is available.
Coding Tips
Attempt to conduct the interview with ALL residents. This interview is conducted during the look-back period of the Assessment Reference Date (ARD) and is not contingent upon item B0700, Makes Self Understood. If the resident needs an interpreter, including a resident who uses American Sign Language (ASL), every effort should be made to have an interpreter present for the BIMS. If it is not possible for a needed interpreter to participate on the day of the interview, code C0100 = 0 to indicate interview not attempted and complete C0600- C1000, Staff Assessment for Mental Status. If the resident interview was not conducted within the look-back period (preferably the day before or the day of) the ARD, item C0100 must be coded 1, Yes, and the standard “no information” code (a dash “-”) entered in the resident interview items. Do not complete the Staff Assessment for Mental Status items (C0700–C1000) if the resident interview should have been conducted but was not done. Because a PDPM cognitive level is utilized in the speech language pathology (SLP) payment component of PDPM, only in the case of PPS assessments, staff may complete the Staff Assessment for Mental Status for an interviewable resident when the resident is unexpectedly discharged from a Part A stay prior to the completion of the BIMS. In this case, the assessor should enter 0, No in C0100: Should Brief Interview for Mental Status Be Conducted? and proceed to the Staff Assessment for Mental Status. C0200–C0500: Brief Interview for Mental Status (BIMS) C0200–C0500: Brief Interview for Mental Status (BIMS) (cont.)
Item Rationale
Health-related Quality of Life
Direct or performance-based testing of cognitive function decreases the chance of incorrect labeling of cognitive ability and improves detection of delirium. Cognitively intact residents may appear to be cognitively impaired because of extreme frailty, hearing impairment or lack of interaction. Some residents may appear to be more cognitively intact than they actually are. If cognitive impairment is incorrectly diagnosed or missed, appropriate communication, worthwhile activities and therapies may not be offered. The BIMS is an opportunity to observe residents for signs and symptoms of delirium.
Planning for Care
Assessment of a resident’s mental state provides a direct understanding of resident function that may: — enhance future communication and assistance and — direct nursing interventions to facilitate greater independence such as posting or providing reminders for self-care activities. A resident’s performance on cognitive tests can be compared over time. — An abrupt change in cognitive status may indicate delirium and may be the only indication of a potentially life-threatening illness. — If performance worsens, then an assessment for delirium and/or depression should be considered, as a decline in mental status may also be associated with a mood disorder. Awareness of possible impairment may be important for maintaining a safe environment and providing safe discharge planning. Steps for Assessment: Basic Interview Instructions for BIMS (C0200– C0500) 1. Refer to Appendix D for a review of basic approaches to effective interviewing techniques.
2. Interview any resident not screened out by Should Brief Interview for Mental Status Be
Conducted? (Item C0100).
3. Conduct the interview in a private setting, if possible.
4. Be sure the resident can hear you.
Residents with hearing impairment should be tested using their usual communication devices/techniques, as applicable. Try an external assistive device (headphones or hearing amplifier) if you have any doubt about hearing ability. Minimize background noise. C0200–C0500: Brief Interview for Mental Status (BIMS) (cont.)
5. Sit so that the resident can see your face. Minimize glare by directing light sources away
from the resident’s face.
6. Give an introduction before starting the interview.
Suggested language: “I would like to ask you some questions. We ask everyone these same questions. This will help us provide you with better care. Some of the questions may seem very easy, while others may be more difficult.” 7. If the resident expresses concern that you are testing their memory, they may be more comfortable if you reply: “We ask these questions of everyone so we can make sure that our care will meet your needs.” 8. Directly ask the resident each item in C0200 through C0400 at one sitting and in the order provided.
9. If the resident chooses not to answer a particular item, accept their refusal and move on to the
next questions. For C0200 through C0400, code refusals as incorrect/no answer or could not recall.
Coding Instructions
See coding instructions for individual items.
Coding Tips
If the interviewer is unable to articulate or pronounce any cognitive interview items clearly, for any reason (e.g., accent or speech impairment), have a different staff member conduct the BIMS. Rules for stopping the BIMS before it is complete: — Stop the interview after completing (C0300C) “Day of the Week” if:
1. all responses up to this point have been nonsensical (i.e., any response that is unrelated,
incomprehensible, or incoherent; not informative with respect to the item being rated), OR 2. there has been no verbal or written response to any of the questions up to this point, OR 3. there has been no verbal or written response to some questions up to this point and for all others, the resident has given a nonsensical response.
DEFINITION
COMPLETE INTERVIEW The BIMS is considered complete if the resident attempted and provided relevant answers to at least four of the questions included in C0200– C0400C. Relevant answers do not have to be correct but do need to be related to the question that was asked. C0200–C0500: Brief Interview for Mental Status (BIMS) (cont.) If the interview is stopped, do the following:
1. Code (—), dash in C0400A, C0400B, and C0400C.
2. Code 99 in the BIMS Summary Score (C0500), and if the assessment being
completed is a stand-alone Part A PPS Discharge, continue to C1310. Signs and Symptoms of Delirium. Otherwise, proceed to step 3.
3. Code 1, yes in C0600, Should the Staff Assessment for Mental Status be
Conducted?
4. Complete the Staff Assessment for Mental Status.
If all responses to C0200, C0300A, C0300B, and C0300C are coded 0 because answers are incorrect, continue interview. When staff identify that the resident’s primary method of communication is in written format, the BIMS can be administered in writing. The administration of the BIMS in writing should be limited to only this circumstance. See Appendix E for details regarding how to administer the BIMS in writing. Code 0 is used to represent three types of responses: incorrect answers (unless the item itself provides an alternative response code), nonsensical responses, and questions the resident chooses not to answer (or “refusals”). Since 0s resulting from these three situations are treated differently when coding the BIMS Summary Score in C0500, the interviewer may find it valuable to track the reason for each 0 response to aid in accurately calculating the summary score. Examples of Incorrect and Nonsensical Responses
1. Interviewer asks resident to state the year. The resident replies that it is 1935. This answer is
incorrect but related to the question.
Coding: This answer is coded 0, incorrect but would NOT be considered a
nonsensical response.
Rationale: The answer is wrong, but it is logical and relates to the question.
2. Interviewer asks resident to state the year. The resident says, “Oh what difference does the
year make when you’re as old as I am?” The interviewer asks the resident to try to name the year, and the resident shrugs.
Coding: This answer is coded 0, incorrect but would NOT be considered a
nonsensical response.
Rationale: The answer is wrong because refusal is considered a wrong answer, but the
resident’s comment is logical and clearly relates to the question.
DEFINITION
NONSENSICAL RESPONSE Any response that is unrelated, incomprehensible, or incoherent; it is not informative with respect to the item being rated. C0200–C0500: Brief Interview for Mental Status (BIMS) (cont.)
3. Interviewer asks the resident to name the day of the week. Resident answers, “Sylvia, she’s
my daughter.” The interviewer asks the resident the question again to confirm the resident is not hearing the question incorrectly, and the resident answers with the same response.
Coding: The answer is coded 0, incorrect; the response is illogical and nonsensical.
Rationale: The answer is wrong, and the resident’s comment clearly does not relate to
the question; it is nonsensical.
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
NPE - PPS DC
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
PDPM
Marker: +
supporting item
Locator: MDS Item Matrix v1.20.1 v4
QRP Standardized (A0310B = 01 and/or A0310H = 1)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Shared NH/SB Subsets
IPA - Interim Payment
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
Item Subset Required Use ISC Skip Patterns
APU Item Admission (A0310B = 01)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
APU Item Discharge (A0310H = 1)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
QRP PPS 5 Day Admission (A0310B = 01)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
QRP PPS DC (A0310H = 1)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
PDPM (A0310B = 01 or 08)
Marker: +
supporting item
Locator: MDS Item Matrix v1.20.1 v4