MDS Alert

Published on Wed Nov 06, 2019 PDF

Question: One of my residents receives frequent evaluations by various clinicians, but I’m not sure which credentials count as “physician” for MDS item O0600 (Physician Examinations).

New York Subscriber

Answer: The Centers for Medicare & Medicaid Services (CMS) does not require all facilities to code MDS item O0600, but some states do require it. If your state requires this item, you should look at medical progress notes for the resident within the 14-day lookback period.

The RAI Manual says, on page O-50, that the following credentials or roles qualify for examination: “… medical doctors, doctors of osteopathy, podiatrists, dentists, and authorized physician assistants, nurse practitioners, or clinical nurse specialists working in collaboration with the physician as allowable by state law.”

The examination can occur in a physician’s office or during a telehealth visit (eligibility requirements must be met for a telehealth visit to be billable, which may not directly affect whether the visit constitutes an “examination”). If the physician examination occurs off-site, “it can be coded as a physician examination as long as documentation of the physician’s evaluation is included in the medical record. The physician’s evaluation can include partial or complete examination of the resident, monitoring the resident for response to the treatment, or adjusting the treatment as a result of the examination,” the RAI Manual says.

Important: Licensed psychologist visits or examinations should be coded in O0400E (Psychological Therapy) instead of this item; the RAI Manual specifies that a licensed psychologist credentialed with a PhD should not be coded as a physician visit. Any resident visits or examinations by medicine men (or other traditional healers) should not be coded in item O0600 (Physician Examination).