Audits of Schizophrenia Coding and Antipsychotics

Posted by LTCS on March 12, 2023

With the ongoing goal to reduce the use of unnecessary antipsychotics, CMS will be conducting audits of schizophrenia coding in MDS data. They will adjust the Nursing Home Care Compare star ratings for facilities whose audits reveal inaccurate coding.

Inappropriate use of antipsychotic medications has been a wide-spread problem in facilities for a very long time, and became worse during and since the pandemic. Past surveys noted in many facilities an absence of comprehensive psychiatric evaluations and behavior documentation. Also, many residents had only sporadic behaviors noted in their medical records, and these behaviors were related to dementia, rather than schizophrenia.

When residents are given erroneous schizophrenia diagnoses, they are subject to poor care and unnecessary antipsychotic medications, both of which can be very dangerous, a recent CMS memorandum stated.

CMS Memorandum Antipsychotic Medications and Schizophrenia