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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MDS Lookup
Urinary Continence
Item Rationale
Matrix review
6 matrix group(s) are already attached for review on this item.
Answer coverage
5 governed answer row(s) are attached for this item.
Answer Codes
Code 0
Always continent
if throughout the 7-day look-back period the resident has been continent of urine, without any episodes of incontinence.
Code 1
Occasionally incontinent
if during the 7-day look-back period the resident was incontinent less than 7 episodes. This includes incontinence of any amount of urine s...
Code 2
Frequently incontinent
if during the 7-day look-back period, the resident was incontinent of urine during seven or more episodes but had at least one continent vo...
Code 3
Always incontinent
if during the 7-day look-back period, the resident had no continent voids.
Code 9
Not rated
if during the 7-day look-back period the resident had an indwelling bladder catheter, condom catheter, ostomy, or no urine output (e.g., is...
What this item is
Item Rationale
When to use it
Use this item when the facility is completing content tied to Section H and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page H-9
- CMS exact locator: Manual page H-9
- This item has 5 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 H-9
CMS exact locator
Manual page H-9
Full CMS Text
Item Rationale
Health-related Quality of Life
Incontinence can — interfere with participation in activities, — be socially embarrassing and lead to increased feelings of dependency, — increase risk of long-term institutionalization, — increase risk of skin rashes and breakdown, — increase risk of repeated urinary tract infections, and — increase the risk of falls and injuries resulting from attempts to reach a toilet unassisted.
Planning for Care
For many residents, incontinence can be resolved or minimized by — identifying and treating underlying potentially reversible causes, including medication side effects, urinary tract infection, constipation and fecal impaction, and immobility (especially among those with the new or recent onset of incontinence); — eliminating environmental physical barriers to accessing commodes, bedpans, and urinals; and — bladder retraining, prompted voiding, or scheduled toileting. For residents whose incontinence does not have a reversible cause and who do not respond to retraining, prompted voiding, or scheduled toileting, the interdisciplinary team should establish a plan to maintain skin dryness and minimize exposure to urine.
Steps for Assessment
1. Review the medical record for bladder or incontinence records or flow sheets, nursing
assessments and progress notes, physician history, and physical examination.
2. Interview the resident if they are capable of reliably reporting their continence. Speak with
family members or significant others if the resident is not able to report on continence.
3. Ask direct care staff who routinely work with the resident on all shifts about incontinence
episodes.
DEFINITIONS
URINARY INCONTINENCE The involuntary loss of urine. CONTINENCE Any void that occurs voluntarily, or as the result of prompted toileting, assisted toileting, or scheduled toileting.
Coding Instructions
Code 0, always continent: if throughout the 7-day look-back period the resident has
been continent of urine, without any episodes of incontinence.
Code 1, occasionally incontinent: if during the 7-day look-back period the
resident was incontinent less than 7 episodes. This includes incontinence of any amount of urine sufficient to dampen undergarments, briefs, or pads during daytime or nighttime.
Code 2, frequently incontinent: if during the 7-day look-back period, the resident
was incontinent of urine during seven or more episodes but had at least one continent void. This includes incontinence of any amount of urine, daytime and nighttime.
Code 3, always incontinent: if during the 7-day look-back period, the resident had
no continent voids.
Code 9, not rated: if during the 7-day look-back period the resident had an indwelling
bladder catheter, condom catheter, ostomy, or no urine output (e.g., is on chronic dialysis with no urine output) for the entire 7 days.
Coding Tips and Special Populations
If intermittent catheterization is used to drain the bladder, code continence level based on continence between catheterizations.
Examples
1. An 86-year-old resident has had longstanding stress-type
incontinence for many years. When they have an upper respiratory infection and are coughing, they involuntarily lose urine. However, during the current 7-day look-back period, the resident has been free of respiratory symptoms and has not had an episode of incontinence.
Coding: H0300 would be coded 0, always
continent.
Rationale: Even though the resident has known intermittent stress incontinence, they were continent
during the current 7-day look-back period.
2. A resident with multi-infarct dementia is incontinent of urine on three occasions on day one
of observation, continent of urine in response to toileting on days two and three, and has one urinary incontinence episode during each of the nights of days four, five, six, and seven of the look-back period.
Coding: H0300 would be coded as 2, frequently incontinent.
Rationale: The resident had seven documented episodes of urinary incontinence during
the look-back period. The criterion for “frequent” incontinence has been set at seven or more episodes over the 7-day look-back period with at least one continent void.
DEFINITION
STRESS INCONTINENCE Episodes of a small amount of urine leakage only associated with physical movement or activity such as coughing, sneezing, laughing, lifting heavy objects, or exercise.
3. A resident with Parkinson’s disease is severely immobile and cannot be transferred to a toilet.
They are unable to use a urinal, and the incontinence is managed by the resident using adult briefs and bed pads that are regularly changed. They did not have a continent void during the 7-day look-back period.
Coding: H0300 would be coded as 3, always incontinent.
Rationale: The resident has no urinary continent episodes and cannot be toileted due to
severe disability or discomfort. Incontinence is managed by a “check and change” protocol.
4. A resident had one continent urinary void during the 7-day look-back period, after the nursing
assistant assisted them to the toilet and helped with clothing. All other voids were incontinent.
Coding: H0300 would be coded as 2, frequently incontinent.
Rationale: The resident had at least one continent void during the look-back period. The
reason for the continence does not enter into the coding decision.
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
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
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
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
A0310G=2 UPD
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Item Subset Required Use ISC Skip Patterns
QRP PPS 5 Day Admission (A0310B = 01)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4