Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
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BIMS Summary Score
Item Rationale
Matrix review
7 matrix group(s) are already attached for review on this item.
Answer coverage
1 governed answer row(s) are attached for this item.
Answer Codes
Code 99
Unable to complete interview
if (a) the resident chooses not to participate in the BIMS, (b) if four or more items were coded 0 because the resident chose not to answer...
What this item is
Item Rationale
When to use it
Use this item when the facility is completing content tied to Section C and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page C-16
- CMS exact locator: Manual page C-16
- This item has 1 governed answer row(s) attached.
Source awareness
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
Source & Review
Manual
CMS MDS 3.0 RAI Manual v1.20.1
Status
Published
Effective start
2025-10-01
Item locator
Manual page C-16
CMS exact locator
Manual page C-16
Full CMS Text
Item Rationale
Health-related Quality of Life
The total score: — Allows comparison with future and past performance. — Decreases the chance of incorrect labeling of cognitive ability and improves detection of delirium. — Provides staff with a more reliable estimate of resident function and allows staff interactions with residents that are based on more accurate impressions about resident ability.
Planning for Care
The BIMS is a brief screener that aids in detecting cognitive impairment. It does not assess all possible aspects of cognitive impairment. A diagnosis of dementia should only be made after a careful assessment for other reasons for impaired cognitive performance. The final determination of the level of impairment should be made by the resident’s physician or mental health care specialist; however, these practitioners can be provided specific BIMS results and the following guidance: The BIMS total score is highly correlated with Mini-Mental State Exam (MMSE; Folstein, Folstein, & McHugh, 1975) scores. Scores from a carefully conducted BIMS assessment where residents can hear all questions and the resident is not delirious suggest the following distributions: 13-15: cognitively intact 8-12: moderately impaired 0-7: severe impairment Abrupt changes in cognitive status (as indicative of a delirium) often signal an underlying potentially life-threatening illness and a change in cognition may be the only indication of an underlying problem. Care plans can be more individualized based upon reliable knowledge of resident function.
Steps for Assessment
After completing C0200–C0400:
1. Add up the values for all questions from C0200 through C0400.
2. Do not add up the score while you are interviewing the resident. Instead, focus your full
attention on the interview.
Coding Instructions
Enter the total score as a two-digit number. The total possible BIMS score ranges from 00 to 15. If the resident chooses not to answer a specific question(s), that question is coded as incorrect and the item(s) counts in the total score. If, however, the resident chooses not to answer four or more items, then the interview is coded as incomplete and the Staff Assessment for Mental Status is completed. To be considered a completed interview, the resident had to attempt and provide relevant answers to at least four of the questions included in C0200–C0400. To be relevant, a response only has to be related to the question (logical); it does not have to be correct. See general coding tips below for residents who choose not to participate at all.
Code 99, unable to complete interview: if (a) the resident chooses not to
participate in the BIMS, (b) if four or more items were coded 0 because the resident chose not to answer or gave a nonsensical response, or (c) if any but not all of the BIMS items are coded with a dash (—). — Note: a 0 score does not mean the BIMS was incomplete. For the BIMS to be incomplete, a resident must choose not to answer or must give completely unrelated, nonsensical responses to four or more items. If one or more of the 0s in C0200– C0300 are due to incorrect answers, the interview should continue.
Coding Tips
Occasionally, a resident can communicate but chooses not to participate in the BIMS and therefore does not attempt any of the items in the section. This would be considered an incomplete interview; enter 99 for C0500, BIMS Summary Score, and complete the Staff Assessment for Mental Status. If all of the BIMS items are coded with a dash, then C0500, BIMS Summary Score must also be coded with a dash.
Examples
1. The resident’s scores on items C0200–C0400 were as follows:
C0200 (repetition) C0300A (year) C0300B (month) C0300C (day) C0400A (recall “sock”) C0400B (recall “blue”) C0400C (recall “bed”) Coding: C0500 would be coded 12 (Sum of C0200–C0400C). C0600. Should the Staff Assessment for Mental Status be Conducted? is coded as 0, No, and the skip pattern is followed.
2. The resident’s scores on items C0200–C0400C were as follows:
C0200 (repetition) C0300A (year) C0300B (month) C0300C (day) C0400A (recall “sock”) C0400B (recall “blue”) C0400C (recall “bed”) Coding: C0500 would be coded 07 (Sum of C0200–C0400C). C0600. Should the Staff Assessment for Mental Status be Conducted? is coded as 0, No, and the skip pattern is followed.
3. The resident’s score on items C0200–C0400C were as follows:
C0200 (repetition) 0 (no response provided) C0300A (year) 0 (nonsensical response provided) C0300B (month) 0 (nonsensical response provided) C0300C (day) 0 (no response provided and the interview was stopped) C0400A (recall “sock”) (—) C0400B (recall “blue”) (—) C0400C (recall “bed”) (—) Coding: C0500 would be coded 99, resident was unable to complete the interview.
Rationale: The interview was stopped because the resident did not respond to two
questions and provided nonsensical responses to two questions. Since the resident did not attempt to answer two questions and did not provide relevant answers to two questions, the BIMS interview is considered incomplete.
Matrix Applicability
Nursing Home Subsets
NC - Comprehensive
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NQ - Quarterly
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
ND - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NPE - PPS DC
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Program and Policy Use
Care Area Triggers
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NHQI Quality Measures
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
PDPM
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
QRP Standardized (A0310B = 01 and/or A0310H = 1)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
QRP Quality Measures (Includes risk adjustment)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Swing Bed Subsets
SP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
SD - Discharge
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Shared NH/SB Subsets
IPA - Interim Payment
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Stand Alone Assessments
OBRA Admission A=01, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Quarterly A=02, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Annual / Sig Chg A=03, B=99, F=99, G=^, H=0 A= 04, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Discharge A=99, B=99, F=10, 11, G=1, 2, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
D/C Items (Only when A0310F = 10 or 11)
A0310G=1 PDC
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Item Subset Required Use ISC Skip Patterns
APU Item Admission (A0310B = 01)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
APU Item Discharge (A0310H = 1)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
QRP PPS 5 Day Admission (A0310B = 01)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
QRP PPS DC (A0310H = 1)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
PDPM (A0310B = 01 or 08)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4