MO190, MO210, M0230, and MO240

hoolahan, ASN, RN · Jul 25, 2004

Barry, this is one of the hardest areas on the oasis even for experienced nurses. It has to do w a lot of things, first let me pull an oasis, i don't have these memorized.

MO 190, yes for conditioins treated in last 14 days...so if they were in a rehab for the last 3 weeks, it could be that the reason for admit is gait dysfunction, and not the urosepsis they were admitted to the acute facility for.

MO 210 relates to MO 200, so if your pt was in for CHF, freq flyer, and there was no med change, you answer 200 no, and leave 210 blank. This may be more the case for your Medicaid patient's, or chronic patient's like with MS who you see to maintain the foley, neurogenic bladder.

If pt was NIDDM, and now is on insulin, you answer 200 yes, and put in insulin dep DM.

(At my agency, they do not want us to code, just put diagnoses.)

220, relates to conditions present before the admit, so, if the pt has alzheimer's w impaired decision making, or is known to be non-compliant, it is not expected that you may be showing an improved outcome when d/c oasis is compared to SOC oasis.

For MO230 and 240, I have worked for 3 diff HH agencies and they each had us do it differently. And even tho Medicare wants/OK's use of V codes now, my present agency now does not want us to put V-codes in, they just want us to list diagnoses, and the manager will put in order of severity, and add V-codes. It doesn't make sense, but that is how they want it.

Yes, sometimes, the diagnoses from 190 and 210 are repeated, like HTN or CHF, but if the pt was in for pneumonia, they are not d/c with pneumonia, so you need to look at another diagnosis, like are they a COPD'er? Asthma? Debilitated from the hospital stay related to the pneumonia? If they are admitted with urosepsis, they should not be d/c with it, so that would not be a good homecare diagnosis for 230/240

My other agency did want us to use V-code. So, for example, if you are admitting someone for care of a foley after TURP, you would put "Aftercare of urinary devices" or whatever the V-code is in line one. Then, in the grey-shaded area, you would put the corresponding diagnosis, like BPH, or Prostate Ca. IF the person also needed PT, you put PT in line 2 and then in the second grey area you put gair dysfunction, or debility.

Now, it was creating problems b/c I thought the foley was the most important reason for admit, but a manager may want PT as #1, b/c I think that gets a higher HHRG.

All I can really tell you is 1. Do it the way your manager wants you to (don't be surprised if 2 managers tell you 2 different things, it is confusing to say the least), and 2. always put the reasn for home care as the number one. Why does the member need skilled nursing? New CHF? What meds do they need teaching on? BP/cardiac meds, or is it the fact that now they are on insulin in addition to their po meds? Then maybe IDDM needs to be the first diagnosis.

If I had 2 weekday managers and the 2 weekend sups' each take my diagnoses lists and put them in order based on what I tell them, I can tell you there will be a minimum of 2 different ways they order the diagnoses.

Best thing to do is ask your supervisor, or the person who will be reviewing your oasis how they expect it done, that way, you will have less paperwork coming back to you for corrections. We have an oasis manager now, so if I am working a weekday, I just call her and ask her how she thinks it shoud be done.

You do know about the MO questions and how they relate to higher, or lower, reimbursement for Medicare under PPS? So, if you are kind of torn, always pick trauma, diabetes, or neuro first, IF APPLICABLE of course, if you have a few active HH diagnoses, your agency will get reimbursed higher. The problem I have is when a sup wants to put DM first when the pt has had NO DM med changes, and is well-controlled, but we really need to see them s/p pacemaker insertion, or a CHF re-admit. To me that is falsely padding the bill, but they intial their changes, so it's on them if it's a problem down the road.

barryg · Jul 26, 2004

Thanks so much! Very helpful.

Barry

Joella · Aug 8, 2004

Thanks so much! Very helpful.
Barry

Hello,

New to the list, please forgive if I type in the wrong place.

I am a coder and QA. Here is a report you will use over and

over again. It takes you step by step thru Oasis, gives you

easy to understand suggestions for each M0 question. It is

113 pages but you could download. I have mine in a binder to

refer to daily, I make copies of certain M0 questions to help

educate the Field RN's making the Oasis visits. They brought

clinicians from across the country together to gleen from their

experiences in answering each Oasis question and give clear

answers on how the questions are to be answered properly,

it is great, every RN Home Health performing Oasis visits needs

a working copy.

http://www.fazzi.com/3MNOIP.pdf

renerian, BSN, RN · Aug 8, 2004

You have captured perfectly the issues with OASIS. LOL each company wants it done differently. Very hard to teach that way isn't it. I don't mind the OASIS just the usual greyness to the tool. People do not always fit into those neat little boxes.

renerian

barryg · Aug 12, 2004

Not to mix metaphors, but that file was a goldmine!!! Thanks so much!

Barry

Hello,
New to the list, please forgive if I type in the wrong place.
I am a coder and QA. Here is a report you will use over and
over again. It takes you step by step thru Oasis, gives you
easy to understand suggestions for each M0 question. It is
113 pages but you could download. I have mine in a binder to
refer to daily, I make copies of certain M0 questions to help
educate the Field RN's making the Oasis visits. They brought
clinicians from across the country together to gleen from their
experiences in answering each Oasis question and give clear
answers on how the questions are to be answered properly,
it is great, every RN Home Health performing Oasis visits needs
a working copy.
http://www.fazzi.com/3MNOIP.pdf

hoolahan, ASN, RN · Aug 12, 2004

I agree with you Barry, that was a wonderful site!! Thanks Joella. Keep posting, huh?! :)

Home Health Columnist / Guide · Aug 13, 2004

from cms: oasis diagnosis reporting

http://www.cms.hhs.gov/providers/hhapps/diagnosis.pdf

http://kb.goldenrulesoftware.com/article.asp?id=207

final report of the 3m national oasis integrity project

the 3m national oasis integrity project, sponsored by nahc, the 3m corporation, and fazzi associates, was designed to help clinicians generate more accurate and consistent responses to the extensive list of outcome and assessment information set (oasis)questions.

recommended questions and techniques for oasis m0 items

http://www.nahc.org/nahc/legreg/3mnoip.pdf

diagnosis coding for m0230/m0240 and m0245 (effective 10/01/2003)

down load pages 145 to 152 from cms regs found at:

http://www.cms.hhs.gov/oasis/rev8.pdf