routinely perform these assessments and therefore lose their comfort level with the assessment of a particular system. When it is agency policy that therapists will perform the OASIS Patient tracking items Twenty-three items make up the part of OASIS known as the Patient Tracking section , which identifies agency and patient demographic information. These are OASIS items that are usually completed just once during a patient’s stay in home care because they usually do not change during this time. Three items refer to the home health agency. One item – M0018 – identifies the physician who will be overseeing the patient’s care and signing the orders for the patient’s stay in home care. Patient demographic information included in the Patient Tracking section consists of items which includes the patient’s name, birthdate, Social Security number, gender, race/ethnicity, Clinical record items The Clinical Record Items section includes information about why the OASIS assessment is being performed (M0100; Start of Care? Transfer? Resumption of Care? Recertification? Discharge?), who is performing the assessment (M0080; registered nurse? physical therapist? occupational therapist? speech-language pathologist?), and the date on which the assessment was actually completed (M0090). One question – M0110 – determines whether the patient has had home care services over an extended period. This particular question is rather complex. Although information from the patient and Patient history and diagnoses The Patient History and Diagnosis section of OASIS contains 12 items some of which are quite complex. The first items (M1000-M1005) ask about the patient’s recent history and are asked only at start of care and resumption of care. The CMS uses these items for risk adjustment. Therapists can use these items to better understand patients’ recent experiences and therapies, for assistance in developing care plans that are more patient centered. These items include questions about the type of inpatient facilities from which the patient was discharged over the past 14 days (M1000) and the date of the patient’s discharge from the last inpatient facility (M1005). In question M1000 about inpatient facilities, note that item instructions direct the therapist to “Mark all that apply” and that the last response option instructs the therapist to skip the next M item. Both of these types of directives are seen in multiple other OASIS items, and it is important to be vigilant about following these instructions to select several responses and skip items when appropriate. Question M1000 illustrates another convention: the need to be mindful of the time period the item is asking the therapist to consider when selecting responses. In this question, the item’s instructions ask that the therapist consider only the last 14 days. The Response-Specific Instructions for this item instructs the therapist to begin the 14- day count by identifying the start of care date as Day 0 and then counting back 14 days, using the entire 14-day period as the time to consider when assessing the appropriate diagnoses. Item M1021/1023 appears to be very complex, but if the agency has office staff or utilizes outsourced coders that apply the ICD-10 codes and sequencing rules, the therapist will need only to identify the patient’s home care diagnoses and the degree to which the diagnoses are controlled. The primary diagnosis, listed as M1021 at the top spot in the far left column, is defined as “the chief reason the patient is receiving home care and the diagnosis most related to the current home health Plan of Care.” In other words, the primary diagnosis is the one that will require most of a clinician’s time and effort and is the reason for the majority of the interventions listed on the plan of care (POC). Then the therapist needs to decide the remaining secondary diagnoses or comorbidities that should be listed in M1023 in the order of how much time and effort they each require of the clinicians. Sometimes the patient’s list of secondary diagnoses is longer than the five items allowed in the body part of OASIS,
assessments, it should be ascertained that the therapists are skilled and confident in the assessment of all the systems addressed in OASIS.
and the state and zip code where the patient receives home care services. Additional information includes the patient’s start-of- care date or resumption-of-care date, and information about the source of payment for the patient’s care including the patient’s Medicare or Medicaid number. If any of this information does change – if, for example, the patient switches from the Medicare Advantage program to regular Medicare – the therapist needs to alert a supervisor, who will help change Patient Tracking data or order a new OASIS completion according to the agency’s policies. caregiver about their recent experiences in home care can be used to complete this question, best practice requires a check of Medicare’s Health Insurance Query for home health systems. This query is typically performed by office staff, so the therapist needs to determine who that is and how this item is completed at the agency. Two questions (M0102, M0104) ask about the date the patient was referred for home care services and if the physician ordered a specific date on which home care services should begin. so the therapist needs to prioritize the five secondary diagnoses that require the most intensive services, listing them in descending order. OASIS-D allows up to 24 secondary diagnoses to be listed on the claim. Another challenge in answering M1021/1023 is determining the level of symptom control for the primary and five secondary diagnoses. This information is recorded in the second column of the item’s matrix. Identifying the appropriate symptom control requires careful attention to the definitions of the codes for each symptom control level. Another group of items attempts to identify the patient’s risk factors for home care complications and the acuity of the patient’s needs while in home care. Question M1028 asks whether the patient has any of three diagnoses that put the patient at high risk for pressure ulcers and poor functional outcomes. Question M1030 asks about three specific therapies that patients may be receiving while in home care, and M1033 identifies factors that are associated with risk for being hospitalized. Question M1060 asks about the patient’s height and weight, identifying risk factors related to low or elevated body mass index values. Each of these items has important implications for the care plans that therapists should develop. For example, any factors identified during the item assessing the risk for hospitalization should be addressed with strategies on the POC that mitigate or attempt to resolve the factor. The last set of items in the Patient History and Diagnoses section is made up of four items related to flu and pneumonia immunizations. Unlike all the previous items in the Patient History and Diagnoses section, which are asked during start of care, resumption of care, and sometimes at recertification, the immunization items are asked only at transfer or discharge. The purpose of these items is to determine whether the agency used best practices in the care of the patient – that is, if the agency ensured that the patient obtained recommended immunizations. Answering this item in a desirable way at discharge – being able to record that the agency addressed and facilitated patient immunization during the stay in home care – requires the case- managing therapist to think proactively about the patient’s immunization status at admission, ensuring that the patient has had the immunizations or providing the immunizations before discharging the patient.
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Book Code: PTCA2622B
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