[NRSKarenRN]

Advice from CAHABA, my agency's Medicare intermediary

From MedicareA Newsline 1/1/05, Vol 12, No 4, Pgs. 66 -70
https://www.cahabagba.com/part_a/edu...etter/0105.pdf
link updated 2/21/07
4/08--link no longer available


Reminder and Updates to “Helpful Tips on Completion of the OASIS”

The article Helpful Tips on Completion of the OASIS was published in the October 1, 2003, Medicare A Newsline. Our Medical Review department continues to deny services based on inappropriate coding of the weighted Outcome & Assessment Information Set (OASIS) M0 items. Therefore, as a reminder, the tips are being repeated, and have been updated as necessary. These tips address reimbursement issuesrelated to the 23 specific OASIS M0 locators used for payment of claims under the Home Health Prospective Payment System (HH PPS). Please share the following information with your staff.



General

TIP 1 - If M0 locators are not easily identified in your agency’s comprehensive assessment, you may highlight or bold these areas in the medical record documentation, so they are not missed during medical review.

TIP 2 – When you receive an Additional Development Request (ADR) for medical records, ensure the correct OASIS is sent for the Health Insurance Prospective Payment System (HIPPS) code(s)billed on the claim that received the ADR request. If a Significant Change in Condition (SCIC) is billed, a corresponding OASIS should be sent for each of the HIPPS codes billed.



M0175 Inpatient Discharge

TIP 1 – Obtain this information from the referral source, the hospital discharge planner, or the physician. Also verify the information by accessing the eligibility screen ELGA, as described in the June 1, 2004, Medicare A Newsline article Medicare Resources for Researching InpatientDischarges within 14 Days of a Home Health Admission. This can be found on our Web site at:

http://www.iamedicare.com/Provider/newsroom/newslines/newslines.htm

TIP 2 – When counting the 14-day period for discharge from a facility, count your day of home health admission or recertification as day 0, the previous day as day 1, etc.

TIP 3 – Remember that more than one response may be checked for this M0 locator. If a patient was discharged from both a hospital and a Skilled Nursing Facility (SNF) in the past 14 days, responses 1 and 3 should both be checked for M0175.



M0230 Primary Diagnosis

TIP 1 – The ICD-9-CM code and narrative used as the primary diagnosis on the Plan of Care should match the primary diagnosis on the OASIS.

TIP 2 – The primary diagnosis is the main reason you are seeing the patient in their home and the diagnosis that requires the most intensive skilled services. If the patient is a diabetic, but is being seen only for a monthly B12 injection, the primary diagnosis would be Pernicious Anemia, not Diabetes.


TIP 3 – The clinician performing the OASIS assessment visit is the person responsible for completing locator 230/240 and assigning the primary diagnosis code after verifying with the physician. Although clerical or other professional staff in your office may fill in the ICD-9-CM code itself, only the original clinician who filled out the OASIS is allowed to make any changes to the diagnoses on the OASIS form. If the clinician is making any changes, he/she must correct errors by crossing through with one line and initial and date the correction. Any changes made to OASIS locator 230/240 that are not initialed and dated by the clinician may be considered alterations to the medical record, and may not be allowed.


TIP 4 – Our data analysis has revealed that the orthopedic, neurological and diabetes ICD-9-CM codes that result in higher reimbursement are being utilized much more frequently now than prior to PPS. Because up-coding is a vulnerability in the PPS program, this is an area we look at closely when reviewing our data; therefore, we encourage you to be sure that you use these categories of codes correctly.

TIP 5 – Only use the “ Open Wound” codes from the Injury and Poisoning category (ICD-9 codes 870-897) when there has been a traumatic injury to cause the wound. The documentation should support this occurrence.

TIP 6 – Specific examples of correct coding are provided by the Centers for Medicare & MedicaidServices (CMS) at: http://www.cms.hhs.gov/providers/hhapps/diagnosis.pdf



M0240 Secondary Diagnosis

TIP 1 – Only specific neurological and orthopedic codes make a difference in reimbursement when used as a secondary diagnosis. These are codes that cannot be used as a primary code and are indicated in the ICD-9-CM book. These secondary, or manifestation codes, must be paired with an appropriate primary diagnosis from the ICD-9-CM book to be allowed for additional payment.

[NRSKarenRN]

M0250 Therapies
TIP 1 – Insulin pumps, subcutaneous, epidural, and intrathecal infusions being delivered in the home all qualify as infusion therapy.
TIP 2 – Any IV therapy administered outside the home does not qualify as infusion therapy unless the maintenance flushing of the line is being done in the home.
TIP 3 – Nutrients must be given through a feeding tube to qualify as enteral therapy; water alone is not enough.



M0390 Vision
TIP 1 –Vision should be assessed with corrective lenses. Reading glasses purchased at a drug store are considered corrective lenses; magnifying glasses are not.
TIP 2 – Patients with partially or severely impaired vision are likely to require some adaptations to the care plan as a result of these limitations, so it is likely that additional assessments or care plan interventions would be documented. If the patient cannot read medication labels, but takes medications independently, documentation should support how that is accomplished.

M0420 Pain
TIP 1 – Remember that response 0 may be used when the patient experiences pain, but the pain does not interfere with activity or movement.
TIP 2 – If pain is controlled with medication, response 0 may be appropriate.


M0440 Wound with a Trauma Diagnosis
TIP 1 – ICD-9-CM codes 870 – 894 for open wounds are only to be used if the wound was a result of an injury. The 870 – 894 series of codes should not be used for diabetic, pressure or stasis ulcers, or surgical wounds.
TIP 2 – Not all wounds or lesions fit into categories of trauma, pressure, stasis or surgical. Even though other types of wounds are important to document, they do not receive additional reimbursement in the PPS system.



M0450 Current Number of Pressure Ulcers at Each Stage

TIP 1 – A diabetic foot ulcer is not a pressure ulcer. If the physician states the ulcer is a diabetic ulcer, even though it may have been initially caused by pressure, it became an ulcer because of the diabetes.

TIP 2 – Note the change by CMS for documenting healed stage 1 and 2 ulcers on the OASIS as of September 1, 2004. This can be found on the CMS Web site at:
http://www.cms.hhs.gov/oasis/npuap.pdf


During the start of care (SOC) or subsequent comprehensive assessments of the patient, if it is found that a patient has a healed Stage 1 or 2 pressure ulcer, the responses for OASIS data items are as follows:

(M0440) Does this patient have a Skin Lesion or Open Wound?

• If the patient has a healed Stage 1 pressure ulcer (and no other pressure ulcers OR skin lesions/wounds), the response would be ‘No’.

• If the patient has a healed Stage 2 pressure ulcer (and no other pressure ulcers OR skin lesions/wounds), the response may be either ‘No’ or ‘Yes’, depending on the clinician’s physical assessment of the healed wound site.

• If the patient has no scar tissue formation from the healed Stage 2 pressure ulcer, the accurate response is ‘No’.

• If the patient has some residual scar tissue formation, the response is ‘Yes’.


(M0445) Does this patient have a Pressure Ulcer?

• If the patient has a healed Stage 1 or 2 pressure ulcer (and no other pressure ulcers), the accurate response is ‘No’, following the skip pattern as indicated. Reverse staging during the healing process is still not appropriate, i.e., a stage 2 pressure ulcer does not become a stage 1 pressure ulcer; it remains a stage 2 pressure ulcer until it is healed.

NOTE: For accurate responses for healed Stage 3 and healed Stage 4 pressure ulcers, theguidance remains unchanged as noted in the OASIS Implementation Manual under theassessment strategies for (M0450) Current Number of Pressure Ulcers. Since the underlying skin architecture of a healed stage 3 or stage 4 pressure ulcer is dramatically
and permanently altered, there is increased risk of future ulcerations. Therefore, the correct responses for documenting a healed Stage 3 or 4 pressure ulcer on the

OASIS assessment is:

• M440 = 1, ‘Yes’, patient has a skin lesion

• M0445 = 1 ‘Yes’, patient has a pressure ulcer

• M0450 and 460 = appropriate stage when ulcer was deepest

• M0464 = 1, fully granulated (currently best response)



M0476 Status of the Most Problematic Stasis Ulcer

TIP 1 – This category is for venous stasis ulcers only, not arterial ulcers.

TIP 2 – Stasis ulcers are most commonly found from the ankle to knee, not on the toes.



M0488 Status of the Most Problematic Surgical Wound

TIP 1 – A pressure ulcer that has been skin grafted remains a pressure ulcer. When a muscle flap is done to cover a pressure ulcer, it becomes a surgical wound because the pressure ulcer is gone.
TIP 2 – A debrided ulcer does not become a surgical wound. The ulcer retains its original etiology.



M0490 Shortness of Breath

TIP 1 – Documentation of dyspnea should be consistent among all services in the home. If inconsistencies exist, such as no dyspnea noted in the physical therapy (PT) notes when the patient is ambulating 100 feet but the skilled nurse (SN) documents dyspnea after 20 feet, points may not be allowed for M0490 and the claim may be downcoded if the reason for the difference is notdocumented in the medical record.

[NRSKarenRN]

M0530 Urinary Incontinence

TIP 1 – Skip this locator if the patient has any type of catheter – indwelling, intermittent straightcatheterizations, suprapubic or condom catheter.

TIP 2 – If a patient has been incontinent, but a catheter is inserted on the initial assessment visit,skip this locator.



M0540 Frequency of Bowel Incontinence

TIP 1 – If the patient is on a bowel program and the response to this locator indicates the patient is still incontinent, the incontinence should be addressed in the documentation.



M0610 Behaviors

TIP 1 – The behaviors described in this locator are severe manifestations of altered cognitive or neurological/emotional status. The fact that an elderly person is a little forgetful does not support the behaviors in this category.



General questions about completing each OASIS locator and timing of completion of the OASIS should be referred to your state OASIS Education Coordinator. Go to http://www.cms.hhs.gov/oasis/ on the Centers for Medicare & Medicaid Services (CMS) Web site for contact information for the OASIS Education Coordinator in your state. Scroll down and click on the State OASIS Education Coordinatorslink.

[KJS]

Originally Posted by NRSKarenRN

M0530 Urinary Incontinence

TIP 1 – Skip this locator if the patient has any type of catheter – indwelling, intermittent straightcatheterizations, suprapubic or condom catheter.

TIP 2 – If a patient has been incontinent, but a catheter is inserted on the initial assessment visit,skip this locator.



M0540 Frequency of Bowel Incontinence

TIP 1 – If the patient is on a bowel program and the response to this locator indicates the patient is still incontinent, the incontinence should be addressed in the documentation.



M0610 Behaviors

TIP 1 – The behaviors described in this locator are severe manifestations of altered cognitive or neurological/emotional status. The fact that an elderly person is a little forgetful does not support the behaviors in this category.



General questions about completing each OASIS locator and timing of completion of the OASIS should be referred to your state OASIS Education Coordinator. Go to http://www.cms.hhs.gov/oasis/ on the Centers for Medicare & Medicaid Services (CMS) Web site for contact information for the OASIS Education Coordinator in your state. Scroll down and click on the State OASIS Education Coordinatorslink.

I wish I had known about this message board when I was in home health. Your posts would have made my wrestle with OASIS so much easier. Thanks!

[annfLA]

I went to a seminar about the oasis and we were told to always answer yes for does the patient have a skin leison..b/c they can have a mold or scar and this is considered a skin leison

[nrsjen]

In respose to the previous entry, our consultant has also said that the majority of patients will have a skin lesion, and that a skin lesion is defined as any alteration in the color, texture or integrity of the skin, to paraphrase. Also, another tip that we have our patients do to answer the majority of the functional assessment questions is to walk to the bathroom, and step in and out of the tub, if able. This gets ambulation, transferring etc. out of the way. Also, it makes the patients think we are crazy! Also, for the questions regarding dressing oneself, you have to take into consideration whether or not the patient is able to dress himself in what he would usually wear. I.E. if a patient always wore lace up shoes, but now has to wear slip ons due to inablility to tie them or to reach down far enough, that would be considered a functional deficit.

[NRSKarenRN]

FRom Diagnoisis coding Pro
How to ease off use of V57.1 and improve coding accuracy

[NRSKarenRN]

How to fine tune your OASIS questions and properly document:

3M OASIS Integrity Project 2008 revision
Updated Recommended Questions and Techniques for OASIS M0 Items

[NRSKarenRN]

From: Quality Insights of PA

Coding:
Documentation Tips for the Top Ten DRGs

Quality Insights of Pennsylvania’s coding site added 4/08

[DutchgirlRN]

I haven't seen this website posted here before. I found it informative.

www.oasistraining.org