CMS released a revised RAI manual on July 20, 2022. According to the RAI Errata V2 dated July 15, 2022 revisions include instructions on coding Section I related to coding Schizophrenia on the MDS. The Errata notes specific circumstances when nursing homes should not code Schizophrenia, despite the physician diagnosing the resident with Schizophrenia, if there is not clinical evidence to support the diagnosis of Schizophrenia, and nursing homes should report the potential misdiagnosis to the Board of Medicine or Board of Nursing as appropriate. The RAI provides the following clinical example of when Schizophrenia has been misdiagnosed:
On page I-16, added a supporting example. 4. The resident was admitted without a diagnosis of schizophrenia. After admission, the resident is prescribed an antipsychotic medication for schizophrenia by the primary care physician. However, the resident’s medical record includes no documentation of a detailed evaluation by an appropriate practitioner of the resident’s mental, physical, psychosocial, and functional status (§483.45(e)) and persistent behaviors for six months prior to the start of the antipsychotic medication in accordance with professional standards. Coding: Schizophrenia item (I6000), would not be checked.
Rationale: Although the resident has a physician diagnosis of schizophrenia and is receiving antipsychotic medications, coding the schizophrenia diagnosis would not be appropriate because of the lack of documentation of a detailed evaluation, in accordance with professional standards (§483.21(b)(3)(i)), of the resident’s mental, physical, psychosocial, and functional status (§483.45(e)) and persistent behaviors for the time period required.
