Inaccurate MDS Coding for Falls and Insulin Use
Penalty
Summary
The facility failed to ensure accurate completion of Minimum Data Set (MDS) assessments for multiple residents. For one resident admitted from the hospital with a closed left scapular fracture after a fall at home, the Admission/Medicare 5-Day MDS dated 2/13/2026 was coded in Section J1800/1900 to show two falls since admission to the facility, one with no injury and one with a major injury. Record review showed the resident had not experienced any falls in the facility since admission on 2/9/2026, and the DON confirmed there were no in-facility falls for this resident. The inaccurate coding therefore reflected falls that did not occur during the resident’s stay. Another resident’s record showed two documented in-facility falls, one on 2/11/2026 with no injury and one on 2/16/2026 with injury (except major). These two falls were correctly captured on the 2/20/2026 End of PPS Part A Stay MDS in Section J1800/1900 as one fall with no injury and one fall with injury (except major). However, the subsequent Discharge Return Anticipated MDS dated 2/28/2026 was also coded to show one fall with no injury and one fall with injury (except major), despite there being no documentation of any additional falls after those already recorded on the 2/20/2026 assessment. The DON confirmed that the resident had only the two documented falls and no further incidents. For a third resident, the Quarterly MDS assessment dated 2/26/2026 contained inaccurate medication coding. In Section N0350 (Insulin), the assessment indicated that insulin injections were received on seven days during the look-back period. Review of the electronic medical record revealed there were no orders for insulin for this resident. During interview, the MDS Coordinator explained that Ozempic had been coded as an insulin, and acknowledged this as an error. These findings demonstrate that the facility did not consistently perform accurate MDS assessments for falls and insulin use as required by the assessment tool.
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