Incorrect MDS Coding of GLP-1 Medication as Insulin
Penalty
Summary
The facility failed to ensure accurate coding of the Minimum Data Set (MDS) assessment for a resident with type 2 diabetes, morbid obesity, and a history of intestinal bypass. The resident was prescribed Trulicity, a GLP-1 receptor agonist, for diabetes management. However, in two consecutive comprehensive MDS assessments, the medication was incorrectly coded as insulin in Section N (Medications). Documentation and medication reference materials clearly indicate that Trulicity is not insulin, but rather a non-insulin injectable medication used to improve glycemic control in adults with type 2 diabetes. Interviews with the DON and a corporate RN revealed that MDS assessments were completed offsite, with input from unit managers and the onsite MDS coordinator responsible for scheduling and ensuring timely completion. The staff acknowledged a potential gap in training regarding GLP-1 medications. Facility policy requires accurate assessment and documentation from multiple sources, including clinical records, to support MDS coding, but this process was not followed in this instance, resulting in the incorrect coding of the resident's medication.