Inaccurate MDS Coding for Hospice Status and Diabetes Medication
Penalty
Summary
The deficiency involves inaccurate coding of Minimum Data Set (MDS) assessments for two residents. One resident with active diagnoses including anemia, heart failure, and diabetes mellitus elected hospice services on 1/19/26, as documented on an Election of Benefits for Hospice form. However, the resident’s admission MDS assessment dated later in January did not indicate that she was receiving hospice care. During interview, the MDS Coordinator stated he relied on the census report when completing the MDS and that the census report had not been updated to reflect the resident’s hospice admission, resulting in the hospice status not being captured on the MDS. The Administrator confirmed that MDS assessments should accurately reflect a resident’s hospice status. The second resident was admitted with a diagnosis of type 2 diabetes mellitus and had a physician’s order for Ozempic (semaglutide) to be administered subcutaneously once weekly for diabetes management. The medical record and MARs for October and November did not show any orders or documentation for insulin administration, but the November MAR documented administration of Ozempic on 11/1/25. The resident’s quarterly MDS assessment indicated that the resident received one insulin injection in the last seven days. In interview, the MDS nurse reported she coded the MDS to show one insulin injection based on the Ozempic administration, explaining she believed that because Ozempic was ordered for diabetes, it should be coded as insulin. The MDS Director clarified that Ozempic is not insulin and should not be coded as such, and the Administrator stated that MDS assessments should accurately reflect the medications residents receive.
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