Under Medical Record Review, why are MDS assessments coded with Isolation in Section O reclassified to a lower RUG?

A: The RAI Manual provides clear instruction on the coding of Isolation. Documentation must support the medical necessity of Isolation. There must be:

1) An MD order

2) Documentation to support the need for a private room

3) Documentation to support the need for the resident to remain in their room

In many cases, isolation continued for extended periods of time with no documentation to support medical necessity, or for conditions that are excluded, such as wound infections, are reclassified into a RUG category without the Isolation indicator upon audit. Further information can be found in Chapter 3 Section O of the RAI User's Manual.