MDS Item of the week: Subitem P1bdA, Respiratory therapy

Editor's note: This week's edition of Ask SNFInfo includes an excerpt of an article titled "Breathe easier financially: Hone assessment skills to capture respiratory therapy on the MDS," from the newsletter PPS Alert. Expect more helpful tips and advice from PPSA in every issue to come!

Subitem P1bdA, respiratory therapy/number of days, is one of the 108 payment items used in the Resource Utilization Group (RUG) grouper for PPS.

Item P1bdA can help classify a resident into the special care RUG category or it can factor into the total "extensive count" to place a resident in a specific RUG group within the extensive services category

It is also worth noting that accurately coding all qualifiers for the upper-35 RUGs can help you maintain administrative presumption during medical review if reviewers find that the primary skilled services were not reasonable and necessary.

Finally, item P1bd can significantly affect Medicaid payments in some states, such as Indiana. "Accurately coding respiratory therapy on the MDS provides a huge financial advantage in Medicaid case-mix states by generating a higher RUG score, especially during flu season, when respiratory treatments are more common," says Ronald Orth, RN, NHA, RAC-CT, CPC, owner and president of Clinical Reimbursement Solutions, LLC, in Milwaukee.

Respiratory therapy treatments that can be coded in item P1bd include coughing, deep breathing, heated nebulizers, aerosol treatments, assessing breath sounds, and mechanical ventilation. Misunderstandings about the criteria for capturing these respiratory therapy services and inadequate documentation systems contribute to the undercoding of respiratory therapy services, says Orth.