Ask Proactive – I would like to code isolation for a resident who has COVID and was in single room isolation for 4 days in the look-back period. However, the therapy documentation reports 2 episodes of the resident walking in the hallway. Can we still code isolation?

I would like to code isolation for a resident who has COVID and was in single room isolation for 4 days in the look-back period. However, the therapy documentation reports 2 episodes of the resident walking in the hallway. Can we still code isolation?

A:

Isolation does not need to be provided for the entire look-back period. If all requirements were met for any day in the 14-day look-back, you can code isolation. As a best practice, the medical record should be clear for the portion of the look-back period that strict isolation did occur. Isolation should not be coded on the MDS if documentation supports that the resident did come and go from their room without clear confirmation that strict isolation precautions were maintained for at least one day that was reasonable and necessary for the active infection during the look-back period. Clarifying documentation of this sort will further support coding accuracy considering the observation period for isolation is 14 days and the observation period for Section G items (i.e., Walk in corridor, Locomotion on/off unit) is only 7 days.

RAI guidance, pg. O-5

O0100M, Isolation for active infectious disease (does not include standard precautions)

Code only when the resident requires transmission-based precautions and single room isolation (alone in a separate room) because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission. Do not code this item if the resident only has a history of infectious disease (e.g., s/p MRSA or s/p C-Diff – no active symptoms). Do not code this item if the precautions are standard precautions, because these types of precautions apply to everyone. Standard precautions include hand hygiene compliance, glove use, and additionally may include masks, eye protection, and gowns. Examples of when the isolation criterion would not apply include urinary tract infections, encapsulated pneumonia, and wound infections.

Code for “single room isolation” only when all of the following conditions are met:

1. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.
2. Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.
3. The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.
4. The resident must remain in his/her room. This requires that all services be brought to the resident (e.g. rehabilitation, activities, dining, etc.).

The following resources are being provided to help the facility interdisciplinary team determine the best method to contain and/or prevent the spread of infectious disease based on the type of infection and clinical presentation of the resident related to the specific communicable disease. The CDC guidelines also outline isolation precautions and go into detail regarding the different types of Transmission-Based Precautions (Contact, Droplet, and Airborne).

• • • 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html
    • SHEA/APIC Guideline: Infection Prevention and Control in the Long Term Care Facility http://www.apic.org/Resource_/TinyMceFileManager/Practice_Guidance/id_APIC-SHEA_GuidelineforICinLTCFs.pdf