-: Okay, thank you, Kristie. And welcome everyone.
I hope you're enjoying the training
and finding the sessions helpful.
As Kristie noted, My name is Lisa Newton
and I will be reviewing coding scenarios
for the pain interview.
I'm a registered nurse with experience
in direct patient care, clinical education,
and executive level administration in both the acute care
and LTCH settings.
And currently, I am a senior staff associate
at Econometrica in Bethesda, Maryland.
The pain interview in Section J
is new to the IRF and LTCH settings.
We're looking at three new items:
J0510 pain effect on sleep,
J0520 pain interference with therapy activities,
and J0530 pain interference with day-to-day activities.
To help you with coding the Section J scenarios,
I invite you to access the dataset for your setting.
For the IRF-PAI, the pain interview items
can be found on page 13 of the admission assessment PDF.
And for the LCDS, the pain interview is located
on page 17 of the admission assessment.
Just one caveat about the item sets.
Some of the coding examples in this session
involve discharge scenarios.
So if you're using the IRF-PAI,
you can just scroll within the PDF to the discharge section
later in the document.
For the LCDS, we'll be using the planned discharge item set,
which is a separate PDF if you wish to access that.
Let's begin coding with J0510 pain effect on sleep.
Here are the coding instructions for J0510.
You'll code 0, does not apply,
if the patient responds that they did not have any pain
or hurting in the past five days.
Code 1, rarely or not at all,
if the patient responds that pain has been present
and the pain rarely or not at all made it hard to sleep
in the past five days.
Code 2, occasionally,
if the patient responds that pain has occasionally
made it hard to sleep in the past five days.
Code 3, frequently.
Code 4 for almost constantly,
and you'll use code 8, unable to answer,
if the patient is unable to answer the question,
does not respond, or gives a nonsensical response.
Our first scenario involves a patient
admitted to the post-acute care or PAC setting
after a 10-day stay in an acute care hospital
for the repair of a right hip fracture.
A nurse is completing the admission assessment.
The admitting nurse asked the patient,
"Over the past five days, how much of the time
has pain made it hard for you to sleep at night?"
The patient responds,
"The pain was unbearable at the hospital last week
and I wasn't sleeping.
I know that I was on a lot of medication there,
but now I'm not sure what day it is.
Is this Saturday?"
The nurse responds, "Yes, this is Saturday.
Can you recall when your most recent episode of pain was?"
The patient responds, "No, I really cannot remember."
How would you code J0510 pain effect on sleep?
Would it be option A, code 2, occasionally?
B, code 3, frequently?
C, code 4, almost constantly?
Or D, code 8, unable to answer?
And I see that the poll is open,
so we'll give you just a little bit of time to respond.
Okay, I think we can go ahead and close the poll
and move on to see what our responses were.
And it looks like the majority of you
coded D, code 8, unable to answer.
And in fact, that is the correct response.
The rationale for this answer
is that the patient reports that pain has been present,
but is unsure of the day
and cannot fully recall the last five days.
The nurse reorients the patient to the correct day
and then prompts them to think
about the most recent episode of pain to try to determine
whether it occurred within the lookback period.
Since the patient is unable to remember,
the most appropriate response is code 8, unable to answer.
Let's consider scenario two.
In this example, we'll be coding a discharge item.
So this item can be located on page 25 of the IRF-PAI
and on page 14 of the LCDS planned discharge item set.
A patient is preparing for discharge from the PAC setting
after recovering from a major automobile accident.
Upon discharge, the patient was asked by the nurse assessor,
"Over the past five days, how much of the time
has pain made it hard for you to sleep at night?"
The patient responds, "Some nights, I do not sleep at all,
especially when I have done too much during the day.
On those nights, I pace a bit, sit up in the chair
and I might need to ask the nurse for an extra pain pill
or as-needed medication during the night
before I can get back to sleep.
Other nights, I just sleep through the night. No problem."
How would you code J0510 pain effect on sleep?
Would it be response option A,
code 2, occasionally, as it seems like the best fit?
B, code 3, frequently, since it sounds like the patient
was awake a lot due to pain?
C, ask the patient whether this pain has been occasionally
or frequently over the past five days?
Or D, code 8, unable to answer,
as the patient did not give a clear answer?
So the poll is open and we'll give some time to respond.
Okay, I think we can go ahead and close the poll
and see how everyone responded.
And the majority of you selected C.
And in fact, that is the correct answer.
Ask the patient whether this pain has been occasionally
or frequently over the past five days.
And the rationale for this answer
is that since the patient's initial response
did not lead to a clear answer,
the assessor should narrow down the response
by asking additional followup questions about the frequency.
This scenario continues and the nurse does exactly that.
The nurse follows up with a question asking the patient
whether they would consider this pain to be occasionally
or frequently over the past five days.
The patient responds by saying,
"So I guess I would say occasionally
since it only happens now and then."
How would you code J0510?
Would it be option A, code 1, rarely or not at all?
B, code 2, occasionally?
C, code 3, frequently?
Or D, code 4, almost constantly?
And our poll is open, so I will give you a chance
to review those answers and make your selection.
Okay, I think we can go ahead and close the poll
and see what the group thought.
And wow, 97% chose B, code 2, occasionally.
And very good. Excellent, everyone.
That is the answer B, code 2, occasionally.
And the rationale for this answer
is that upon further clarification by the nurse,
the patient does select a designated response option
and reports that over the past five days,
pain has occasionally
made it hard for them to sleep at night.
Now let's move on to several coding examples for J0520
pain interference with therapy activities.
Here are the coding instructions for J0520,
similar to J0510.
You will code 0, does not apply,
if the patient responds that they did not participate
in rehabilitation for reasons unrelated to pain.
So for this, you're gonna think about,
well, either therapy was not needed
or they were unable to schedule it in the past five days.
You'll code 1, rarely or not at all,
if the patient responds that pain has rarely
or not at all limited participation
in rehabilitation therapy sessions in the past five days.
You will code 2, occasionally, if the patient responds
that pain has occasionally limited participation.
Code 3 for frequently,
if the patient responds that pain has frequently limited
participation in rehab in the past five days.
Code 4, almost constantly.
And again, code 8, unable to answer,
if the patient is unable to answer the question,
does not respond, or gives a nonsensical response.
In the next scenario for J0520,
a nurse is completing the admission assessment
and asks the patient, "Over the past five days,
how often have you limited your participation
in rehabilitation therapy due to pain?"
The patient reports, "I have been receiving intravenous
or IV antibiotics for a week now
for the infection in my foot
and have not been seeing anyone for therapy.
I hope they will take this IV out in a few days."
How would you code J0520
pain interference with therapy activities for this patient?
Would it be A, code 0, does not apply?
B, code 1, rarely or not at all?
C, code 8, unable to answer
since the patient obviously has some confusion
due to her infection?
Or D, check with the patient again tomorrow
to see if the IV has been removed and therapy has started?
So the poll is open
and we'll give you just a little bit of time
to react to that question.
Okay, I think we can close the poll
and move on to see how folks responded to that.
And the majority of people chose A, code 0, does not apply.
And let's move along
and see that that is in fact the correct answer,
A, code 0, does not apply.
And our rationale for selecting this answer
is that the patient reports
they are not receiving rehabilitation therapy
due to a foot infection and IV therapy.
So in this case, the most applicable response
would be code 0, does not apply,
because the patient is not participating
in rehabilitation therapy for reasons unrelated to pain.
In scenario four, we have a patient being discharged
from the PAC setting.
The assessor asks the patient, "Over the past five days,
how often have you limited your participation
in rehabilitation therapy due to pain?"
The patient reports,
"I've been able to go to therapy for most of my time here.
I can only recall one instance in the past five days
where my back pain was too severe to exercise."
How would you code J0520
pain interference with therapy activities for this patient?
Would it be A, code 0, does not apply,
since the patient will be receiving therapy
as an outpatient?
Would it be B, code 1, rarely or not at all,
as the patient can only recall
one instance of pain limiting therapy?
Code 2, occasionally, just to be safe
because the patient may have forgotten pain episodes
and underreported their pain?
Or D, code 4, almost constantly,
because you have heard from other staff
that the patient had much more pain
than they are mentioning?
The poll has been open.
Why don't we go ahead and see the responses.
And everyone selected B, code 1, rarely or not at all,
and that is in fact the correct answer.
The rationale is that the patient reported
that back pain limited their participation in therapy
only one time in the past five days.
And just as a quick reminder,
the patient's report of pain frequency should be recorded,
not the assessor's opinion or reports from other staff.
Also, J0520 assesses pain interference with therapy
over the past five days and does not evaluate
anticipated outpatient therapy regimens
after discharge from IRF or LTCH.
And our last item in the pain interview is J0530
pain interference with day-to-day activities.
The next slide will reveal the coding instructions
and I'm not gonna read these
because they are very similar to the way we've been coding,
so we can move on to our scenario.
In this scenario for J0530,
a patient is preparing for discharge
after a postoperative PAC stay for a total knee replacement.
During the discharge assessment,
the nurse assessor asked the patient,
"Over the past five days,
how often have you limited your day-to-day activities,
excluding rehabilitation therapy sessions, because of pain?"
The patient replies, "Most days, I can do what I want to do,
though I was disappointed that I could not attend
the patient and staff Halloween party last week.
I was afraid that sitting for a long time
would be too much for me.
I still have pain in my knee from the surgery.
Some days are good and others are more difficult.
I'm not sure.
I would say that pain limits my day-to-day activities
occasionally to frequently."
How would you code J0530
pain interference with day-to-day activities?
And I see the poll is open,
so would it be A, code 1, rarely or not at all?
B, code 2, occasionally?
C, code 3, frequently?
Or D, code 8, unable to answer,
since the patient could not select a specific response?
So I think we can go ahead and close the poll
and see how folks responded.
And it looks like we had a split between B, C and, D
with most folks selecting code 8.
And actually, the answer to this is C, code 3, frequently.
And let's move along to understand the rationale.
And this is because the patient reported that knee pain
limited their participation
in a holiday celebration at the facility
and that pain has occasionally to frequently
limited their day-to-day activities.
Since the patient couldn't decide
between two frequency response options,
the assessor should code for the option
with the higher frequency.
I just wanna note that this is an important coding concept,
and it applies to all three of the items
in the pain interview.
And our final scenario involves a patient who is transferred
from the acute care hospital
and has been in the PAC setting for just a few days,
recovering from an episode of congestive heart failure.
This patient also has severe rheumatoid arthritis.
The nurse is completing the admission assessment
and ask the patient, "Over the past five days,
how often have you limited your day-to-day activities,
again excluding rehabilitation therapy, because of pain?"
The patient replies,
"I try to do as much as I can throughout the day
and get out of my room,
but I need to stop often to sit down and catch my breath.
My feet are swollen and hurt almost all the time,
so it's hard to walk.
Between my feet and joints, I always have pain,
so I would say that it limits my day-to-day activities.
I don't like taking pain medication,
so I tend to decline when the nurses offer it."
And how would you code J0530 pain interference
with day-to-day activities for this patient?
Would you select option A, code 1, rarely or not at all?
B, code 2, occasionally?
C, code 3, frequently?
Or D, code 4, almost constantly?
And the poll is open, so we'll give you just a few seconds
to select your response.
And I think we can go ahead and close the poll.
And wow, 91% selected D, code 4, almost constantly.
And in fact, that is the correct answer.
So the rationale for this choice
is that the patient reported
that although they try to be active,
pain related to congestive heart failure
and rheumatoid arthritis almost constantly limit
their day-to-day activities.
This concludes our coding scenarios
for the pain interview items.
Before we end this session,
there are just a few important key takeaways
that I'd like to reinforce or key insights.
The pain interview items assess the effect of pain on sleep,
interference with therapy activities,
and interference with day-to-day activities.
The pain interview items should be coded
based on the patient's interpretation
of the provided response options for frequency.
And if the patient is unable to decide
between two response options,
then the assessor should code for the option
with the higher frequency.
For additional information, we encourage you to review
the material in the Section J recorded session,
which is in part one of this training program,
as well as refer to your setting's guidance manual.
Thank you very much for your attention
and I hope that you found this coding session helpful
in applying the new guidance to the pain interview.