The catheter measure counts long-stay residents who had an indwelling catheter at any point in the 7 days before their target assessment. It is one of the long-stay MDS measures in the Five-Star quality rating, worth up to 100 points, and its bands are narrow: full points end at a rate of 0.50%.
What it measures
The CMS name is “Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder (Long Stay),” CMS ID N026.03. The numerator is one item on one assessment:
“Long-stay residents with a selected target assessment that indicates the use of indwelling catheters (H0100A = [1]).”
It is risk-adjusted. It also counts in the Ohio QIP and in Component 4 of the Texas QIPP. The measure is N026.03 in both the v17 and v18 QM User’s Manuals, and the H0100 coding guidance is the same in the October 2026 RAI Manual (v1.20.11) as in v1.20.1.
What counts as an indwelling catheter
H0100A is a look-back item, not a snapshot of the ARD:
“Check next to each appliance that was used at any time in the past 7 days.”
A catheter that was in on day 1 of the look-back and out by day 2 is still coded. H0100A includes suprapubic catheters and nephrostomy tubes, which are coded there and not as ostomies. Three things are coded elsewhere and don’t count toward the measure:
- Intermittent catheterization (straight caths, including self-catheterization) is H0100D.
- A urostomy is an ostomy, H0100C.
- External catheters are H0100B. That includes the newer devices for women:
“Female external catheters and other non-invasive urine output management devices or systems should be coded as external catheters (H0100B).”
Who is left out
A resident is excluded from the measure when any of these is true on the target assessment:
- It is an OBRA admission (A0310A = 01) or a PPS 5-Day (A0310B = 01).
- H0100A is dashed.
- Neurogenic bladder (I1550) is coded active, or the item is dashed.
- Obstructive uropathy (I1650) is coded active, or the item is dashed.
The two diagnoses take the resident out whether or not they have a catheter. There are no other diagnosis exclusions.
The diagnoses have to be real
I1550 and I1650 follow the Section I rules like any other active diagnosis. A physician (or a nurse practitioner, physician assistant or clinical nurse specialist where state law allows) has to have documented the diagnosis in the last 60 days, and it has to be active in the 7-day look-back:
“Active diagnoses are diagnoses that have a direct relationship to the resident’s current functional, cognitive, or mood or behavior status; medical treatments; nursing monitoring; or risk of death during the 7-day look-back period.”
The MDS coordinator can’t infer the diagnosis from the catheter. If a resident has a catheter and the record doesn’t say why, that is a question for the practitioner about the resident’s care. The RAI Manual is plain that an indwelling catheter shouldn’t be used without a valid medical justification. When a physician has documented neurogenic bladder or obstructive uropathy and it is active, it belongs on the MDS. When they haven’t, it doesn’t.
When it clears
The measure reads only the target assessment: the resident’s latest qualifying assessment dated within 120 days of the end of the quarter (or of their discharge). The 7-day look-back is the ARD plus the 6 days before it, so a removed catheter stops being coded once an assessment’s ARD is at least 7 days after the day it came out.
Resident A’s catheter is removed on March 10 after a successful voiding trial. A quarterly with an ARD of March 16 looks back to March 10 and still codes H0100A. With an ARD of March 17 or later, the look-back starts March 11, and if the catheter hasn’t been reinserted, H0100A is not coded.
The ARD still has to fall inside the assessment’s required window. This is knowing when the look-back ends, not moving the rules. Five-Star averages the four most recent quarters, so a quarter with the resident in the numerator stays in the rating until it rolls out.
See your building’s catheter rate, free.
Risk adjustment, in plain words
Two things raise a resident’s expected chance of having a catheter, and both are read from the prior assessment:
- Frequent or always bowel incontinence (H0400 coded 2 or 3)
- A Stage 2, 3 or 4 pressure ulcer (M0300B1, C1 or D1 of 1 or more)
CMS combines those predictions into an expected rate for the building and adjusts your observed rate against it. Coding those two items accurately on every assessment matters, because this quarter’s assessment is usually next quarter’s prior.
How Five-Star scores it
Catheter is one of the 100-point measures, scored in quintiles of the national distribution. Lower is better. Points come from your risk-adjusted four-quarter rate. The cut points were set from 2017Q4–2018Q3 data:
| Four-quarter rate | Points |
|---|---|
| 0.50% or less | 100 |
| 0.51% – 1.26% | 80 |
| 1.27% – 2.17% | 60 |
| 2.18% – 3.56% | 40 |
| 3.57% or more | 20 |
With bands that narrow, one resident can move a smaller building a whole band. SuperQM flags every long-stay resident the catheter measure will count, and the first ARD that would no longer code a removed catheter. See how it works.
