The Brief Interview for Mental Status (BIMS) is a standardized, rapid screening tool used in healthcare settings to quickly assess a person’s cognitive function. This test evaluates several aspects of mental acuity, including attention, orientation, and the ability to register and recall new information. While the test provides a score between 0 and 15 to quantify cognitive status, some individuals encounter an administrative score of 99. Understanding what this specific code means requires looking at the regulatory environment in which the BIMS is administered and how the standard scoring system works.
The Context: Why BIMS is Used in Healthcare Settings
The BIMS assessment is a mandatory component of the Minimum Data Set (MDS), a comprehensive assessment system used primarily in long-term care facilities and skilled nursing facilities in the United States. This standardized set of questions is required by the Centers for Medicare and Medicaid Services (CMS). The purpose of the MDS is to ensure consistent measurement of resident health status and functional capacity across different facilities.
Facility staff, often social workers or nurses, administer the BIMS upon a resident’s admission and periodically (e.g., quarterly) to track changes in cognitive status. Using this uniform tool, facilities monitor a resident’s condition, detect subtle changes, and link the measurement directly to the resident’s individualized care plan and quality measures.
The resulting score helps the care team tailor interventions and support based on the person’s cognitive status. Accurate BIMS scoring is also important for facility reimbursement from Medicare and Medicaid. The cognitive status impacts the case-mix classification, which determines the level of resources and funding a facility receives for a resident’s care. Thus, the BIMS serves both a clinical function for patient care and a regulatory function for facility operations.
Interpreting Standard BIMS Scores (0 to 15)
The standard BIMS score ranges from 0 to 15 points, with higher scores indicating intact cognitive function. The assessment is derived from a series of questions covering three main components: immediate recall, temporal orientation, and short-term memory. Immediate recall is tested by having the individual repeat three unrelated words, such as “sock,” “blue,” and “bed.”
Temporal orientation assesses awareness of the current date and surroundings, asking for the year, month, and day of the week. This section is heavily weighted and can yield up to six points based on response accuracy. The final component, short-term memory, is tested by asking the individual to recall the three words after a brief delay. Points are awarded based on whether the words are recalled spontaneously or with the help of a category cue.
The total score of 0 to 15 is used to categorize the resident’s cognitive status into one of three defined categories. A score of 13 to 15 is considered “Intact,” suggesting no significant cognitive impairment. A score between 8 and 12 indicates “Moderate Impairment,” meaning the individual may have noticeable difficulties with memory and thinking that require extra assistance with certain daily tasks.
A BIMS score ranging from 0 to 7 signifies “Severe Cognitive Impairment.” Individuals in this category are likely to need extensive support and supervision for nearly all cognitive tasks. These categories help the care team quickly understand the general level of cognitive function and adjust the care plan accordingly.
The Administrative Code: What a Score of 99 Signifies
A BIMS score of 99 is an administrative code used within the MDS, not a measure of cognitive function. It signifies that a valid score between 0 and 15 could not be obtained for specific regulatory reasons. This code is used when the interview, intended for all residents, is deemed impossible to finish.
Primary reasons for coding 99 include resident refusal to participate, which regulatory guidelines treat as an incomplete assessment. It is also used when the resident is physically or mentally unable to engage, such as being comatose, severely agitated, or non-responsive. The test is stopped and coded 99 if the individual gives four or more nonsensical or uninformative responses.
If the initial screening suggests the resident is “rarely or never understood” verbally or in writing, or if a needed interpreter is unavailable, the interview should not be attempted and is coded as 99. A score of 99 is distinct from a score of 0, as a score of 0 indicates the interview was completed but the resident answered all questions incorrectly, confirming severe impairment. Coding 99 requires specific documentation within the MDS explaining the reason for the non-completion of the interview.