Isolation Confusion with COVID-19

As skilled nursing facility operators continue to face increasing episodes of either new admissions and or existing residents testing positive for COvID-19, a frequently asked question across providers has been on capturing isolation from a reimbursement standpoint accurately.  With all the changing regulations and the ability to cohort residents, it is essential to go back and provide a brief review of the coding requirement for isolation according to the RAI manual.

According to CMS’s RAI Manual version 3.0, section O0100: Special Treatment, Procedures, and Programs, a resident would be coded as isolation ONLY when the following conditions are met:

  1. Active infection is present with highly transmissible or epidemiologically significant pathogens that have been acquired by:
    • Physical contact
    • Airborne
    • Droplet transmission

    *See CDC guidelines for an outline of isolation precautions regarding different types of transmission-based precautions.

  2. A resident has symptoms of COVID-19 and or tested positive and is in the contagious stage of the disease.
  3. Transmission-based precautions are required, above and beyond standard precautions, including contact, airborne, or droplet precautions.
  4. A resident is in a room alone due to active infection and cannot have a roommate:
    • No cohorting of residents even if they have the same infection
    • Must remain in the room alone
  5. The resident must remain in the room with all activities, dining, and rehabilitation services brought to the resident. 
  6. A facility may transport the resident who meets the criteria for isolation to another healthcare setting to receive medically needed services (dialysis, chemotherapy, blood transfusions, etc.) – only if the facility cannot or does not provide that service. Follow CDC guidelines with regards to transporting patients with a contagious disease.

The RAI manual also provides guidance on examples of conditions and situations that would not qualify as isolation, including:

  1. History of infectious diseases, such as MRSA or C-Diff, with no active symptoms
  2. Standard precautions are being used, which apply to all residents, include hand hygiene, glove use, and additionally, may also include masks, eye protection, and gowns.
  3. Examples of conditions that would not apply for isolation include urinary tract infections, wound infections, or encapsulated pneumonia.

Learn more about RAI guidelines as well as find links to the CDC websites.

Synergy Care Inc. is committed to the health and safety of residents. We remain dedicated to helping our partners and associates not only with the immediate needs associated with COVID-19 but with the potential operational concerns that may change quickly during this difficult time. 

For more information about Synergy Care and how we can help, please contact  If you are looking for additional COVID-19 resources, please view Synergy Care’s COVID-19 resource page at