Incorrect MDS Coding of GLP-1 Medication as Insulin
Penalty
Summary
The facility failed to accurately code the Minimum Data Set (MDS) assessment for a resident with type 2 diabetes mellitus by incorrectly recording the administration of a glucagon-like peptide receptor agonist (GLP-1), specifically Trulicity (Dulaglutide), as insulin. Review of the resident's orders and Medication Administration Record (MAR) confirmed that there was no order for insulin and no insulin was administered during the relevant look-back periods. Despite this, the MDS assessments for two separate quarters indicated that insulin injections had been given on one day during each look-back period. Interviews with the MDS Coordinators revealed a misunderstanding regarding the classification of Trulicity, with one coordinator confirming it is a GLP-1 and not insulin, while the other was unsure. The coordinators stated that previous training from a former regional MDS Director led them to code Trulicity as insulin, but they could not provide documentation to support this practice. The facility's policy requires that the MDS assessment accurately reflect the resident's status during the observation period, which was not followed in this case.