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OutcomeandAssessment InformationSet(OASIS)- E December 2022 HaidehNajafi,BSN,RN,MSED,EDS RAI/MDSandOASISEducationalCoordinator E-mail:najafih@michigan.gov 1
ImportantNotice  This training is current as of the date of this presentation.  Information in this training is not intended to be all inclusive and is not a substitute for current regulations, Center for Medicare and Medicaid Services (CMS) publications, and/or instructions outlined in the current OASIS Guidance Manual, and Update Memorandum. 2
Objective  Describe the Standardized of the assessments in the PostAcute Care (PAC) setting.  Describe current use of OASIS item set.  Describe the reason for data accuracy.  Identify the revised and New items on OASIS-E item set effective January 01, 2023.  Describe the general OASIS item conventions for completing OASIS.  Identify coding instructions and tips for new and updated items. 3
The current uses for OASIS include: 1) Home HealthAgency Medicare-Certification Surveys. 2) The quality measures on the consumer-focused Care Compare website. 3) The quality measures used in the Home Health Quality of Patient Care Star Ratings. 4) The quality measures used in the CMS Home Health Value- Based Purchasing (HHVBP) Model. 4 Overview
5) The QualityAssessment Only (QAO) Metric used in home health pay-for- reporting (P4R). 6) The OASIS instrument also plays a pivotal role in post- acute care quality improvement related to the mandates of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACTAct). 7) Production of quality reports for agencies, 8) Determining reimbursement under Medicare Prospective Payment System (PPS). 5 Overview (cont.)
 Regulatory language stipulates that the encoded OASIS data must accurately reflect the patient’s status at the time the information is collected.  The State survey process for HHAs may include review of OASIS data collected versus data encoded and transmitted to the CMS. 6 DataAccuracy
 Processes to promote data accuracy may include: – Clinical record audits. – Data entry audits. – Reports produced from electronic health record systems or other activities. 7 DataAccuracy
ImprovingMedicarePost-AcuteCare TransformationACT(IMPACTACT)  The Improving Medicare Post-Acute Care TransformationAct (IMPACTAct) of 2014, enacted October 6, 2014.  ThisAct directs the Secretary of Health and Human Services (HHS) to “specify quality measures on which Post-Acute Care (PAC) providers are required under the applicable reporting provisions to submit standardized patient assessment data” in several quality measure domains. 8
StandardizingFunctionattheItemLevel 9 InpatientRehabilitation Facilities PatientAssessment Instrument (IRF-PAI) IRF-PAI Long-TermCare Hospitals ContinuityAssessment Record&Evaluation (CARE)DataSet (LCDS) HomeHealthAgencies OutcomeAssessment InformationSet (OASIS) SkilledNursing Facilities MinimumDataSet (MDS) MDS OASIS LCDS
ImprovingMedicarePost-AcuteCare TransformationACT(IMPACTACT)  The collection of data in a standardized manner facilitate: – Outcome comparison. – Data interoperability. – Comparison of quality within and between PAC settings. – Improve Medicare beneficiary outcomes through: • Shared decision making. • Care Coordination. • Enhanced discharge planning. 10
Implementationof theOASIS-E  These changes will become effective on January 1st, 2023, with OASIS-E. 11
Developan ImplementationStrategy 12 Reviewthe finalizedOASIS-E guidance. Revisepoliciesandprovideeducation andtrainingtoensureagencyreadiness forimplementationonJanuary1,2023. Identifyany impactonITat youragency. Identifythenewstandardized items,updatedguidance,and theimplicationsforyour agency. 1 2 3 4 5 Developanimplementation plantointroducethechanges toyourstaff.
Changes fromOASIS-D toOASIS-E  OASIS-E reflects revisions based on proposals finalized in the: – CalendarYear (CY) 2019 Home Health (HH) Final Rule effective January 1, 2020, and – CY2022 HH Final Rule effective January 1, 2023. 13
Changes fromOASIS-D to OASIS-E  Main reason to revise the OASIS is: – To increase standardization across post-acute (PAC) setting to uniformly collect Social Determination Of Health (SDOH) data. – To enable calculation of standardized, cross- setting Quality Measure (QMs). – Pursuant to the provisions of the Improving Medicare Post-Acute Care Transformation (IMPACT)Act. 14
Changes fromOASIS-D toOASIS-E  With OASIS-E, effective January 1, 2023, the items that were made optional with OASIS-D1 were removed from the specified time points. – M2016 – Patient/Caregiver Drug Education Intervention was also removed from the OASIS instrument. – OASIS-E includes the addition of certain Standardized Patient Assessment Data Elements including those addressing certain Social Determinants of Health (SDOH). 15
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NochangesontheseOASISitems 17 SectionA.AdministrativeInformation:PatientTracking OASIS-E Item # OASIS-D Item # Item Description M0018 M0018 NationalProviderIdentifier(NPI) M0010 M0010 CMSCertificationNumber M0014 M0014 BranchState M0016 M0016 BranchIDNumber M0020 M0020 PatientIDNumber M0030 M0030 StartofCareDate M0032 M0032 ResumptionofCareDate M0040 M0040 PatientName M0050 M0050 PatientStateofResidence
NochangesontheseOASISitems 18 SectionA.AdministrativeInformation:PatientTracking OASIS-E Item # OASIS-D Item # Item Description M0060 M0060 PatientZipCode M0063 M0063 MedicareNumber M0064 M0064 SocialSecurityNumber M0065 M0065 MedicaidNumber M0069 M0069 Gender M0066 M0066 BirthDate M0150 M0150 CurrentPaymentSourcefor HomeCare
NochangesontheseOASISitems 19 SectionA.AdministrativeInformation OASIS-E Item # OASIS-D Item # Item Description M0080 M0080 DisciplineofPersonCompletingAssessment M0090 M0090 DateAssessmentCompleted M0110 M0110 EpisodeTiming M0906 M0906 Discharge/Transfer/DeathDate M1005 M1005 InpatientDischargeDate M2310 M2310 ReasonforEmergentCare M2410 M2410 TowhichInpatientFacilityhasthepatientbeen admitted M0104 M0104 DateofReferral
NochangesontheseOASISitems 20 SectionC.CognitivePatterns OASIS-E Item # OASIS-D Item # Item Description M1700 M1700 CognitiveFunctioning M1710 M1710 WhenConfused M1740 M1740 Cognitive,Behavioral,andPsychiatric Symptoms M1745 M1745 FrequencyofDisruptiveBehavior Symptoms M1720 M1720 WhenAnxious SectionE.Behavior
NochangesontheseOASISitems 21 SectionF.PreferencesforCustomaryRoutine OASIS-E Item # OASIS-D Item # Item Description M1100 M1100 PatientLivingSituation M2102 M2102 TypesandSourcesofAssistance
Nochanges on theseOASISitems 22 SectionG.FunctionalStatus OASIS-E Item # OASIS-D Item # Item Description M1810 M1810 CurrentAbilitytoDressUpperBody M1820 M1820 CurrentAbilitytoDressLowerBody M1840 M1840 ToiletTransferring M1845 M1845 ToiletingHygiene M1850 M1850 Transferring M1860 M1860 Ambulation/Locomotion M1830 M1830 Bathing
NochangesontheseOASISitems 23 OASIS-E Item # OASIS-D Item # Item Description M1600 M1600 Hasthispatientbeentreatedfora UrinaryTractInfectioninthepast 14days? SectionH.BladderandBowel SectionGG.FunctionalAbilities&Goals GG0110 GG0110 PriorDeviceUse
Nochanges on theseOASISitems 24 OASIS-E Item # OASIS-D Item # Item Description J1900 J1900 NumberofFalls SectionJ.HealthConditions M1028 M1028 ActiveDiagnoses–Comorbidities andCo-existingConditions SectionI.ActiveDiagnoses
Nochanges on theseOASISitems 25 OASIS-E Item # OASIS-D Item # Item Description M1060 M1060 HeightandWeight SectionK.Swallowing/NutritionalStatus M1870 M1870 FeedingorEating SectionM.SkinConditions M1307 M1307 OldestStage2PressureUlcer
NochangesontheseOASISitems 26 OASIS-E Item # OASIS-D Item # Item Description M2003 M2003 MedicationFollow-up M2010 M2010 Patient/CaregiverHigh-RiskDrug Education M2020 M2020 ManagementofOralMedications M2005 M2005 MedicationIntervention SectionN.Medications
Nochanges on theseOASISitems 27 OASIS-E Item # OASIS-D Item # Item Description M1046 M1046 InfluenzaVaccineReceived SectionO.SpecialTreatments,Procedures,andPrograms
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OASISItemsremoved 29 OASIS-D Item # Item Description Item/InstructionChange Description M0140 Race/Ethnicity Removed SectionA.AdministrativeInformation:PatientTracking M1200 Vision Removed SectionB.Hearing,Speech,Vision
OASISItemsremoved 30 OASIS-D Item # Item Description Item/InstructionChange Description M1730 Depression Screening Removed M1910 Fall RiskAssessment Removed SectionG.FunctionalStatus SectionD.Mood
OASIS Itemsremoved 31 OASIS-D Item # Item Description Item/InstructionChange Description M1242 FrequencyofPainInterfere withActivity/movement Removed SectionJ-HealthConditions SectionK.Swallowing/NutritionalStatus M1030 Therapiesthepatientreceivesathome Removed
OASISItemsremoved 32 OASIS-D Item # Item Description Item/InstructionChange Description M2016 Patient/CaregiverDrug EducationIntervention Removed M1051 PneumococcalVaccine Removed M1056 ReasonPneumococcalVaccine notreceived Removed SectionN.Medications SectionO.SpecialTreatments,Procedures,andPrograms
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OASISItems-SkipTextRemoved/updated OASIS-E OASIS-D ItemDescription NewItem Item Text Skip Pattern Item/InstructionChange Description 34 SectionA.AdministrativeInformation M0100 M0100 This assessment is currently Being completed for the Following reason X Skip Text removed M0102 M0102 DateofPhysician-OrderedStartof Care(ResumptionofCare) X X Skip text updated M1000 M1000 InpatientFacilities X X Skiptextupdated M2301 M2301 EmergentCare X Skiptextupdated M2420 M2420 DischargeDisposition X Skiptextadded
OASISItems-SkipTextRemoved/updated OASIS-E OASIS- D Item Description NewItem Item Text Skip Pattern Item/InstructionChange Description 35 SectionJ.HealthConditions J1800 J1800 AnyFallsSinceSOC/ROC X Skiptextupdated M1330 M1330 StasisUlcer Skip text updated SectionM.SkinConditions M1306 M130 6 UnhealedPressureUlcer/Injury atStage2orHigher Skiptextupdated M1311 M1311 CurrentNumberofUnhealed PressureUlcers/InjuriesatEachStage Skiptextupdated M1340 M1340 SurgicalWound X Skip text updated
OASISItems-SkipTextRemoved/updated OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 36 SectionN.Medications M2001 M2001 DrugRegimenReview Skiptextupdated M1041 M1041 InfluenzaVaccineData CollectionPeriod X Skiptextupdated SectionO.SpecialTreatments,Procedures,andPrograms
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TextEdit OASIS-E OASIS-D Item Description NewItem ItemText Skip Pattern Item/InstructionChange Description 38 SectionA.AdministrativeInformation M0102 M0102 Date of Physician-Ordered Start of Care (Resumption of Care) X X Text edit:  NA response updated to include ROC  Skip text updated M1000 M1000 Date of Physician-Ordered Start of Care (Resumption of Care) X X Text edit:  Mark all that apply” is replaced with “Check all that apply”  Skip text updated
TextEdit OASIS-E OASIS-D ItemDescription New Item Item Text Skip Pattern Item/InstructionChangeDescription 39 SectionGG.FunctionalAbilities&Goals GG0100 GG0100 PriorFunctioning: EverydayActivities X Text edits:  “all” added to code options 3 – Independent and 1 – Dependent  “any” added to code option 2 – Needed Some Help  “Him/herself” changed to “themself.”  GG0100A, Self Care, reworded to read "...using the toilet, and eating prior...”
TextEdit OASIS-E OASIS-D ItemDescription New Item ItemText Skip Pattern Item/InstructionChangeDescription 40 SectionGG.FunctionalAbilities&Goals GG0130 GG0130 Self-Care X Text edits:  GG0130B,Oralhygiene; “removeandreplace”changed to“insertandremove”inSOC, ROC,andAllItemsversions  Codinginstructions: “Him/herself”changedto “themself.”
TextEdit OASIS-E OASIS-D ItemDescription New Item Item Text Skip Pattern Item/InstructionChangeDescription 41 SectionGG.FunctionalAbilities&Goals GG0170 GG0170 Mobility X X Text edits:  GG0170C, Lying to sitting; “Feet flat on the floor” phrase removed  GG0170M, 1 step, reworded to read “...curb or up and down one step”  Coding instructions: “him/herself” changed to “themself.”
TextEdit OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 42 SectionH.BladderandBowel M1620 M1620 BowelIncontinenceFrequency X Textedit:  “Omit‘UK’optionon FU”textremoved  No,longercollectedatFU M2401 M2401 InterventionSynopsis X Textedit:  RowA-Diabeticfootcare removed SectionQ.ParticipationinAssessmentandGoalSetting
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NotCollectedatFU OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 44 SectionH.BladderandBowel M1610 M1610 UrinaryIncontinenceor UrinaryCatheterPresence NolongercollectedatFU M1630 M1630 OstomyforBowelElimination NolongercollectedatFU M1021 M1021 PrimaryDiagnosis NolongercollectedatFU M1023 M1023 OtherDiagnoses NolongercollectedatFU SectionI.ActiveDiagnoses M1620 M1620 BowelIncontinenceFrequency NolongercollectedatFU
NotCollectedatFU OASIS-E OASIS- D ItemDescription New Item Item Text Skip Patter n Item/InstructionChange Description 45 SectionM.SkinConditions J1330 J1330 StasisUlcer No longer collected at FU M1324 M1324 StageofMostProblematicUnhealed PressureUlcerthatisStageable No longer collected at FU M1322 M1322 CurrentNumberof stageIPressure Injuries No longer collected at FU M1311 M1311 CurrentNumberofUnhealed PressureUlcers/InjuriesatEachStage No longer collected at FU
NotCollectedatFU OASIS-E OASIS-D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 46 SectionM.SkinConditions J1332 J1332 CurrentNumberof StasisUlcers Observable No longer collected at FU J1334 J1334 StatusofMostProblematicStasis UlcerObservable No longer collected at FU J1340 J1340 SurgicalWound X No longer collected at FU J1342 J1342 StatusofMostProblematic SurgicalWoundObservable No longer collected at FU
NotCollectedatFU OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 47 SectionJ.HealthConditions M1400 M1400 WhenispatientdyspneicorSOB? No longer collected at FU Section N. Medications M2030 M2030 ManagementofInjectable Medications No longer collected at FU SectionO.SpecialTreatments,Procedures,andPrograms M2200 M2200 TherapyNeed(#visits) No longer collected at FU
OASIS Items Addto follow-up(withOASIS-D1) 48
Addto Follow-up OASIS-E OASIS-D Item Description NewItem ItemText Skip Pattern Item/InstructionChange Description 49 SectionG.FunctionalStatus M1800 M1800 Grooming AddedtoFU(with OASIS-D1) M1033 M1033 RiskforHospitalization AddedtoFU(with OASIS-D1) SectionJ.HealthConditions
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New SocialDeterminationsOf Health (SDOH) Items New SDOH items for HHA: – A1005- Ethnicity – A1010- Race – A1100- Language – A1250- Transportation – B1300- Health Literacy – D0700- Social Isolation 51
New Non-SDOH Items  New Non- SDOH items for HHA: – A2120-A2124- Transfer of Health information. – B0200- Hearing – B1000- Vision 52
New Items 53 SectionA.AdministrativeInformation:PatientTracking OASIS-E ItemDescription NewItem Item/InstructionChange Description A1005 Ethnicity X M1010 Race X
NewItems 54 SectionA.AdministrativeInformation OASIS-E Item Description NewItem Item/Instruction ChangeDescription A1110 Language X A1250 Transportation X A2120 ProvisionofCurrentReconciledMedicationListto SubsequentProvideratTransfer X A2121 ProvisionofCurrentReconciledMedicationListto SubsequentProvideratDischarge X
NewItems 55 SectionA.AdministrativeInformation(cont.) OASIS-E ItemDescription NewItem Item/Instruction ChangeDescription A2122 RouteofCurrentReconciledMedicationList TransmissiontoSubsequentProvider X A2123 ProvisionofCurrentReconciledMedicationListto PatientatDischarge X A2124 RouteofCurrentReconciledMedicationList TransmissiontoPatient X
NewItems 56 SectionB.Hearing,Speech,Vision OASIS-E Item Description NewItem Item/InstructionChange Description B0200 Hearing X B1000 Vision X Note:  B1000Visionisanewitem ReplacingM1200Vision B1300 HealthLiteracy X
NewItems 57 SectionC.CognitivePatterns OASIS-E Item Description NewItem Item/InstructionChange Description C0100 ShouldBriefInterviewforMentalStatus(C0200- C0500)beConducted X C0200 RepetitionofThreeWords X C0300 TemporalOrientation X C0400 Recall X C0500 BIMSSummaryScore X C1310 SignsandSymptomsofDelirium(fromCAMŠ) X
NewItems 58 SectionD.Mood OASIS-E Item Description NewItem Item/InstructionChangeDescription D0150 PatientMoodInterview(PHQ 2-9) X Note:  D0150PatientMood Interview(PHQ2-9)isa newitem  ReplacingM1730 DepressionScreening
New Items 59 SectionD.Mood(cont.) OASIS-E Item Description NewItem Item/InstructionChangeDescription D0160 TotalSeverityScore X D0700 SocialIsolation X
NewItems 60 SectionJ.HealthConditions OASIS-E ItemDescription New Item Item/InstructionChangeDescription J0510 Pain Effect on Sleep X Note: J0510 Pain Effect on Sleep is a new item Replacing M1242 Frequency of Pain Interfering
NewItems 61 SectionJ.HealthConditions(cont.) OASIS -E ItemDescription New Item Item/InstructionChangeDescription J0520 PainInterferencewith TherapyActivities X Note:  J0520PainInterferencewith TherapyActivitiesisanewitem  ReplacingM1242Frequencyof PainInterfering
NewItems 62 SectionJ.HealthConditions(cont.) OASIS-E ItemDescription NewItem Item/InstructionChangeDescription J0530 Pain Interference with Day-to-DayActivities X Note:  J0530 Pain Interference with Day-to-DayActivities is a new item  Replacing M1242 Frequency of Pain Interfering
NewItems 63 SectionK.Swallowing/NutritionalStatus OASIS-E Item Description NewItem Item/InstructionChangeDescription SectionN.Medications K0520 NutritionalApproaches X N0415 HighRiskDrugClasses:Use andIndication X
NewItems 64 OASIS- E ItemDescription NewItem Item/InstructionChange Description SectionO.SpecialTreatments,Procedures,andPrograms O0110 SpecialTreatments, Procedures, and Programs X
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M2420-DischargeDisposition  Guidance modifying the definition of “formal assistive services” M2420 – Discharge Disposition was updated to support new Transfer of Health Quality Measures:  Code 2, Patient remained in the community (with formal assistive services), now applies if, – After discharge from your agency the patient remained in a non-inpatient setting, receiving skilled services from another Medicare certified home health agency, or – When an agency completes a discharge and new SOC OASIS due to a pay source change for a patient. 66
Non-PhysicianPractitioners Guidance was updated related to allowing orders to be received from select non-physician practitioners, as it impacts OASIS items where the presence of a physician’s order affects the item coding:  Section 3708 of the CoronavirusAid, Relief, and Economic Security (CARES)Act amended section 1861(aa)(5) of theAct, allowing nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) to certify eligibility and provide orders for home health services, where not prohibited by State Law.  Accordingly, when coding OASIS items where the presence of a physician’s order affects the item coding, orders from these allowed practitioners would satisfy the condition of having a physician’s order. 67
M0102–Dateofphysician-orderedSOC/ROC  The date specified by a physician/allowed practitioner order to start home care services or resume home care services regardless of the type of services ordered.  When coding OASIS items where the presence of a physician’s order affects the item coding, orders from an allowed practitioner including physician assistant, nurse practitioner, or other advanced practice nurse would satisfy the condition of having a physician’s order. 68
M0104 –Dateofreferral  A valid referral is considered received when the agency has received adequate information about a patient to initiate patient assessment and confirmed that the referring physician/allowed practitioner or another physician/allowed practitioner, will provide the plan of care (POC)and ongoing orders. 69
M1021-Primarydiagnosis,and M1023–Other diagnoses:  The assessing clinician determine the primary and other home health diagnoses based on the assessment findings, information in the medical record including but not limited to: – Physician/non-physician practitioner orders, – Medication list and referral information, and, – Input from the physician/nonphysician practitioner. 70
OASIS data collection  OASIS data are collected for: – Skilled Medicare and Medicaid patients. – Patients 18 years and older. 71
Whoexcludedfor OASIS data collectionandsubmission?  OASIS data collection and submission are excluded for: – Patients receiving services for pre- or postnatal conditions. – Those receiving only: o Personal care. o Homemaker. o Chore services. 72
OASISandtheComprehensiveAssessment  The comprehensive assessment including OASIS, if applicable, completed by one clinician.  If collaboration with other health care personnel and/or agency staff is utilized, the agency is responsible for establishing policies and practices related to collaborative efforts, including how assessment information from multiple clinicians will be documented within the clinical record, ensuring compliance with applicable requirements, and accepted standards of practice. 73
TimePoints 74 Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Start of care (SOC) 1.Start of care – further visits planned Within 5 calendar days after the SOC date (SOC = Day 0) Resumptionofcare (ROC) 3. Resumptionofcare(after inpatientstay) Within2calendardaysof:  Thefacilitydischargedateor  Knowledgeofpatient’s returnhome
TimePoints 75 Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Follow-up (FU) 4.Recertification (follow-up) assessment Thelast5daysofevery60 days. i.e.,days56-60ofthecurrent 60-dayperiod. 5. Other follow-up Within 2 calendar days of significant change of patient’s condition.
Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Transfer to an Inpatient Facility (TRN) TimePoints 76 6. Transferredtoaninpatient facility–patientnot dischargedfromagency Within2calendardaysof:  Discharge/trans/deathdateor  Knowledgeofaqualifying transfertoinpatientfacility. 7. Transferred to an inpatient facility – patient discharged from agency Within2calendardaysof:  Discharge/trans/deathdateor  Knowledgeofaqualifying transfertoinpatientfacility.
TimePoints 77 Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Discharge from Agency – not to an inpatient facility (DC) 8. Death at home (DAH) Within 2 calendar days of Discharge/Transfer/Death date 9. Discharge from agency (DC) Within 2 calendar days of Discharge/Transfer/Death date.
WhoCompletesOASIS  M0080 (Discipline of Person CompletingAssessment) indicated the comprehensive Start of Care (SOC) assessment including OASIS data collection, if applicable, is the responsibility of: – ARegistered Nurse (RN) in cases involving nursing services. – The Physical Therapist (PT), Speech Language Pathologist/ Speech Therapist (SLP/ST), For a Medicare therapy-only case, conduct SOC comprehensive assessment including OASIS. 78
Who CompletesOASIS (cont.) – Effective January 1, 2022, Occupational Therapist (O.T.) may conduct the SOC comprehensive assessments including OASIS for Medicare patients when the physician’s referral order does not include skilled nursing, but does include PTand/or SLP, along with OT. – Any discipline qualified to perform OASIS assessments (RN, PT, SLP, OT) may complete subsequent OASIS assessments (e.g., transfers, recertifications, resumptions of care, discharge) after the SOC. 79
WhoEstablishMedicareeligibility  Services which establish eligibility for the Medicare home health benefit include: – Skilled Nursing (SN), – PhysicalTherapy (P.T.) – Speech Language Pathology (SLP).  OT does not establish the initial eligibility for the HH benefit. 80
Who cannot CompletesOASIS  The following staff may NOT be responsible for completing the comprehensive assessment and OASIS: – ALicensed Practical Nurse or LicensedVocational Nurse (LPN/LVN), – PhysicalTherapistAssistant (PTA), – OccupationalTherapyAssistant (OTA), – Medical SocialWorker (MSW), – Home HealthAide (HHa). 81
WhoCompletesOASIS  Multidisciplinary cases may have multiple points of discipline-specific discharge, though there is only one HHAdischarge, which must include completion of the comprehensive discharge assessment including OASIS if applicable. 82
General OASIS ItemConventions 1. Understand the time period under consideration (look back) for each item.  Report what is true on the day of assessment unless a different time period has been indicated in the item or related guidance. 83
DayofAssessment  Day of assessment is defined as: – The 24 hours immediately preceding the home visit; and – The time spent by the clinician in the home. 84
GeneralOASISItemConventions 2. For OASIS purposes, in order to be considered a complete quality episode, a quality episode must have: – Abeginning. And – Aconclusion. 85
GeneralOASIS ItemConventions 3.If the patient’s ability or status varies on the day of the assessment, report the patient’s “usual status” or what is true greater than 50% of the time period under consideration, unless the item specifies differently. 4.Minimize the use of “NA” and “Unknown responses.” 86
GeneralOASIS ItemConventions 5. Some items allow a dash response.  Adash (–) value indicates that no information is available.  CMS expects dash use to be a rare occurrence. 87
GeneralOASIS ItemConventions 6. Responses to items documenting a patient’s current status should be based on observation and report of the patient’s condition and ability at the time of the assessment without referring back to prior assessments or documentation of status from a prior care setting. 88
General OASIS ItemConventions 7. Assessment strategies to complete any and all OASIS items include the following, unless otherwise noted in guidance: – Observation. – Interview. – Collaboration with other agency staff. – Other relevant strategies. 89
GeneralOASIS ItemConventions 8. When an OASIS item refers to assistance, this means assistance from another person. 9. Complete OASIS items accurately and comprehensively and adhere to skip patterns. 10. Understand the definitions of words as used in the OASIS. 11. Follow rules included in the item-specific Guidance. 90
General OASIS ItemConventions 12. Stay current with evolving CMS OASIS guidance via updates to the guidance manual and posted Q&Adocuments. 13. The comprehensive assessment includes the OASIS items and is part of the patient’s legal home health agency clinical record. 14. While only the assessing clinician is responsible for accurately completing and signing a comprehensive assessment, they may collaborate to collect data for all OASIS items, if agency policy allows. 91
GeneralOASIS ItemConventions 15.The use of the terms: – “Specifically,” means scoring of the item should be limited to only the circumstances listed.  “For example,” means the clinician may consider other relevant circumstances or attributes when scoring the item. 92
Conventions Specific toOASIS M1800 ADL/IADLItems 1. Report the patient’s physical and cognitive ability to perform a task. Do not report on the patient’s preference or willingness to perform a specified task. 2. Understand what tasks are included and excluded in each item and select the OASIS response based only on included tasks. 93
Conventions Specific toOASIS M1800 ADL/IADLItems 3. While the presence or absence of a caregiver may impact the way a patient carries out an activity, it does not impact the assessing clinician’s ability to assess the patient to determine and report the level of assistance the patient requires to safely complete a task. 94
Conventions Specific toOASIS M1800 ADL/IADLItems 4. The level of ability refers to the level of assistance that the patient requires to safely complete a specified task. Assistance includes:  Verbal cues,  Reminders,  Supervision, and/or  stand-by or hands-on assistance. 95
ConventionsSpecifictoOASISM1800 ADL/IADLItems 5. If the patient’s ability varies between the different tasks included in a multi-task item, report what is true in a majority of the included tasks, giving more weight to tasks that are more frequently performed. 6. Consider medical restrictions when determining ability. 96
OASIS-ESections OASIS-E includes the following sections: 97 Section Title A Administrative Information • PatientTracking B Hearing, Speech, andVision C Cognitive Patterns D Mood E Behavior F Preferences for Customary RoutineActivities G Functional Status GG FunctionalAbilities and Goals
OASIS-E Sections(cont.) OASIS-E includes the following sections: 98 Section Title H Bladder and Bowel I Active Diagnoses J Health Conditions K Swallowing/Nutritional Status M Skin Conditions N Medications O SpecialTreatments, Procedures and Programs Q Participation inAssessment and Goal Setting
TimePointsfornewitems 99 Section Item Description SOC ROC FU TRN DC DAH A 1005 Ethnicity x A 1010 Race x A 1110 Language x A 1250 Transportation x x x A 2120 ProvisionofCurrentReconciled MedicationListtoSubsequent ProvideratTransfer X A 2121 ProvisionofCurrentReconciled MedicationListtoSubsequent ProvideratDischarge X
TimePointsfornewitems 100 Section Item Description SOC ROC FU TRN DC DAH A 2122 RouteofCurrentReconciled MedicationListTransmission toSubsequentProvider X X A 2123 ProvisionofCurrent ReconciledMedicationListto PatientatDischarge X A 2124 RouteofCurrentReconciled MedicationListTransmission toPatient X
TimePointsfornewitems 101 Section Item Description SOC ROC FU TRN DC DAH B 0200 Hearing x B 1000 Vision x B 1300 Health Literacy x x x
TimePointsfornewitems 102 Section Item Description SOC ROC FU TRN DC DAH C 0100 ShouldBriefInterviewfor MentalStatus(C0200-C0500) be Conducted X X X C 0200 RepetitionofThreeWords X X X C 0300 TemporalOrientation X X X C 0400 Recall X X X C 0500 BIMSSummaryScore X X X C 1310 SignsandSymptomsof Delirium(fromCAMŠ) X X X
TimePointsfornewitems 103 Section Item Description SOC ROC FU TRN DC DAH D 0150 PatientMoodInterview (PHQ2-9) X X X D 0160 Total Severity Score X X X D 0700 Social Isolation X X X J 0510 Pain Effect on Sleep X X X J 0520 PainInterferencewith TherapyActivities X X X J 0530 PainInterferencewithDay- to-DayActivities X X X
TimePointsfornewitems 104 Section Item Description SOC ROC FU TRN DC DAH K 0520 NutritionalApproaches X X X N 0415 HighRiskDrugClasses: UseandIndication X X X O 0110 SpecialTreatments, Procedures,and Programs X X X
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A1005:Ethnicity-NewItems 108
A1010:Race-NewItems 109
A1005: EthnicityandA1010- Race  Note: These categories are NOT used to determine eligibility for participation in any Federal program. 110
111 A1005: EthnicityandA1010- Race Patient able to respond Patient unable to respond Patient declines to respond  Checkallthatapply  Checkbox(es)forindicatingethnicity/race categoriesidentifiesbythepatient.  Ifneitherthepatientnor aproxycanprovidea response,usemedical recorddocumentation.  Do not code base on a proxy response or medical record documentation  Aproxymay beused
Codinginstructions A1005- Ethnicity&A1010-Race  Code X, Patient unable to respond: – If the patient is unable to respond. – If the response(s) is/are determined via proxy input, and/or medical record documentation, check all boxes that apply, including Code X - Patient unable to respond. – If the patient is unable to respond, and no other resources provided the necessary information, then only code “X – Patient unable to respond.” 112
Codinginstructions A1005-Ethnicity&A1010-Race  CodeY(Patient declines to respond), in the case that the patient declines to respond. – Only code “Y– Patient declines to respond.” – Do not code base on a proxy input or medical record documentation.  Dash is not a valid response for these items (1005 and 1010). 113
Codinginstructions-A1010:Race Code Z, None of the above, if: – The patient reports or it is determined from proxy or medical record documentation that none of the listed Races apply to the patient. 114
115
A1110: Language- New Items The intent of this item is to identify the patient’s self-reported preferred language and need for an interpreter. 116
A1110A:WhatisyourPreferred Language
Codinginstructions-A1110:Language  Enter the preferred language the patient primarily speaks or understands  Dash is a valid response for this item. – If the patient or any available source cannot or does not identify preferred language, enter a dash (“-“) in the first box. – Adash indicates “no information.” – CMS expects dash use to be a rare occurrence. 118
Codinginstructions-A1110A:Language  Note: An organized system of signing, such as American Sign Language (ASL), can be reported as the preferred language if the patient needs or wants to communicate in this manner. 119
A1110B:WhatisyourPreferred Language
Codinginstructions-A1110B:Language  Code 0, No, if the patient: – Indicates does not want or need of an interpreter to communicate with a doctor or health care staff.  Code 1,Yes, if the patient: – Indicates the need or want of an interpreter to communicate with a doctor or health care staff. 121
Codinginstructions-A1110B:Language  Code 9, Unable to determine: – If no source can identify whether the patient needs or wants an interpreter.  Dash is not a valid response for this item. 122
New Item (SDOH)- SectionA A1250: Transportation 123
A1250: Transportation 124
A1250:Transportation  The intent of this item is to identify access to transportation for ongoing health care and medication access.  Ask the patient: – “In the past six months to a year, has lack of transportation kept you from: • Medical appointments. • Getting your medications. • Non-medical meetings. • Appointments. • Work. • Getting things that you need?” 125
Codinginstructions-A1250:Transportation CodeA,Yes:  If the patient indicates that lack of transportation has kept the patient from: – Medical appointments, or – Getting medications. 126
Codinginstructions-A1250:Transportation Code B,Yes:  If the patient indicates that lack of transportation has kept the patient from: – Non-medical meetings, – Appointments, – Work, – Getting things that the patient needs. 127
Codinginstructions-A1250:Transportation  Code C, No:  If the patient indicates that a lack of transportation has not kept the patient from: – Medical appointments, – Getting medications, – Non-medical meetings, – Appointments, – work, or – Getting things that the patient needs. 128
Codinginstructions-A1250:Transportation  Code X, Patient unable to respond, if the patient is unable to respond.  In the cases where the patient is unable to respond, a response may be determined via proxy input. If a proxy is not able to provide a response, medical record documentation may be used.  If the response(s) is/are determined via proxy input and/or medical record documentation, check all boxes that apply, including Code X - Patient unable to respond.  If the patient is unable to respond and no other resources provided the necessary information, only code X – Patient unable to respond. 129
Codinginstructions-A1250:Transportation CodeY, Patient declines to respond, if the patient declines to respond.  In the cases where the patient declines to respond, Code only “Y– Patient declines to respond.” Dash is not a valid response for this item. 130
131
Important Terms  At the Time of Transfer or Discharge: – This is the period of time as close to the actual time of transfer or discharge as possible. – This time may be based on agency, State, or Federal guidelines for data collection at discharge. 132
Important Terms (cont.)  Current Reconciled Medication List: – This refers to a list of the patient’s current medications at the time of discharge that was reconciled by the agency prior to the patient’s discharge. 133
Definitions  Means of Providing a Current Reconciled Medication List: – Providing the current reconciled medication list at the time of transfer or discharge can be accomplished by any means, including: • Active means. • Passive means. 134
135
A2120 136
A2121 137
A2120andA2121:ProvisionofCurrent ReconciledMedicationListtoSubsequentProvider atTransferandDischarge  The intent of these items is to identify if the home health agency provided a current reconciled medication list to the subsequent provider. 138
Coding Instructions-A2120  For Home Health at Transfer: CompleteA2120 only if: – M0100,ThisAssessment is Currently Being Completed for the Following Reason: 6. Transferred to an inpatient facility – patient not discharged from agency. Or 7. Transferred to an inpatient facility – patient discharged from agency. 139
Coding Instructions-A2121  For Home Health at Discharge: CompleteA2121 only if: – M0100, ThisAssessment is Currently Being Completed for the Following Reason: 9. Discharge fromAgency. And – M2420, Discharge Disposition is: 2. Patient remained in the community (with formal assistive services), Or 3. Patient transferred to a non-institutional hospice. 140
Coding Instructions-A2120 &A2121  Code 0, No, if at transfer or discharge to a subsequent provider, your agency did not provide the patient’s current reconciled medication list to the subsequent provider.  Code 1,Yes, if at transfer or discharge to a subsequent provider, your agency did provide the patient’s current reconciled medication list to the subsequent provider. 141
Coding Instructions  A2120 only: Code 2, NA, if: – At transfer to a subsequent provider, your agency was not made aware of the transfer timely and therefore, unable to provide the patient’s current reconciled medication list to the subsequent provider. Dash is not a valid response for this item. 142
CodingTips (cont.)  At Transfer-Asubsequent provider is identified when the patient has transferred to any inpatient facility.  At Discharge –Asubsequent provider is identified when the patient has been discharged to home under the care of a home health agency or home hospice. 143
CodingTips (cont.)  While the patient may receive care from other providers after discharge from your agency, these locations are not considered to be a subsequent provider for the purpose of coding this item.  Example of provider that are not considered as subsequent provider are: – Primary care providers. – Other outpatient providers. – Residential treatment centers. 144
AdditionalConsiderationsforImportant MedicationListContent  Items that could be on a reconciled medication list include, but are not limited to: – Demographic information. – Allergies and/or adverse reactions. – Special instructions. – Purpose or indication for use. – Current prescribed and over-the-counter medications. 145
ImportantMedicationListContent  Example of medications administered by any route at the time of discharge or transfer, that can be on a reconciled medication list but are not limited to: – Alist of the current prescribed medications. – Over-the-counter medications. – Nutritional supplements. – Vitamins, and/or homeopathic and herbal products. 146
ImportantMedicationListContent(cont.) 1. Areconciled medication list could include important information about the patient including:  Their name.  Date of birth.  Active diagnoses.  Known medication.  Other allergies.  Known drug sensitivities and reactions. 147
ImportantMedicationListContent(cont.) 2. Areconciled medication list could also include important information about each medication including:  The name of the medication.  Strength.  Dose.  Route of medication administration.  Frequency or timing.  Purpose/indication.  Any special instructions. 148
ImportantMedicationListContent(cont.)  Documentation sources for reconciled medication list information include: – Electronic and/or – Paper records.  Examples of such records are: – Discharge summary records. – AMedicationAdministration Record. – An Intravenous MedicationAdministration Record. – Ahome medication list. – Physician orders. 149
New Item-SectionA A2123:ProvisionofCurrentReconciled MedicationListtoPatientatDischarge 150
A2123:ProvisionofCurrentReconciled MedicationListtoPatientatDischarge 151
Intent of theA2123  The intent of this item is to identify if the home health agency provided a current reconciled medication list to the patient, family, and/or caregiver at discharge. 152
Coding Instructions  ForHomeHealthatDischarge:CompleteA2123onlyif: – M0100,ThisAssessmentisCurrentlyBeingCompletedfortheFollowing Reason: 9. DischargefromAgency. And – M2420,DischargeDispositionis: 1. Patientremainedinthecommunity(withoutformalassistiveservices). Or 4. Unknown,becausepatientmovedtoageographiclocationnotservedby thisagency. Or – UK.Otherunknown. 153
CodingInstructions Code 0, No, if at discharge to a home setting, your agency did not provide the patient’s current reconciled medication list to the patient, family, and/or caregiver. Code 1,Yes, if at discharge to a home setting, your agency did provide the patient’s current reconciled medication list to the patient, family, and/or caregiver. Dash is not a valid response for this item. 154
Coding Instructions Patient/family/caregiver:  In order to code “1.Yes”, a current reconciled medication list was transferred.The recipient of the current reconciled medication list can be the: – Patient and/or – Afamily member and/or – Other caregivers. 155
NewItems-SectionA A2122andA2124:RouteofCurrent ReconciledMedicationList TransmissiontoSubsequentProvider andPatient 156
IntentofA2122andA2124  The intent of these items is to identify all routes used in the transmission of the current reconciled medication list to the subsequent provider at transfer or discharge or to the patient. 157
A2122 158
A2124 159
 These items collect important data to monitor how medication lists are transmitted at transfer/discharge to the subsequent provider and at discharge to the patient, family, and caregiver.  The time points to complete these items are: – Transfer (A2122) – Discharge from agency (A2122 andA2124) 160 Item rational
CodingInstructions For Home Health at Transfer, Complete A2122 only if:  M0100,ThisAssessment is Currently Being Completed for the Following Reason: 6. Transferred to an inpatient facility – patient not discharged from agency. Or 7. Transferred to an inpatient facility – patient discharged from agency. 161
CodingInstructions For Home Health at Discharge, Complete A2122 only if:  M0100, ThisAssessment is Currently Being Completed for the Following Reason is: 9. Discharge fromAgency. And  M2420, Discharge Disposition is: 2. Patient remained in the community (with formal assistive services). Or 3. Patient transferred to a non-institutional hospice. .162
CodingInstructions ForHomeHealthatDischarge completeA2124onlyif:  M0100,ThisAssessmentisCurrentlyBeingCompletedfortheFollowing Reason: 9. DischargefromAgency. And  M2420,DischargeDispositionis: 1. Patientremainedinthecommunity(withoutformalassistiveservices). Or 4. Unknown,becausepatientmovedtoageographiclocationnotservedby thisagency. Or • UK.Otherunknown. 163
CodingInstructions CodeA2122A/A2124A, Electronic Health Record (EHR), if  Your agency has an EHR and used it to transmit or provide access to the reconciled medication list to the subsequent provider, patient, family, and/or caregiver. This would include: – Situations where both the discharging and receiving provider have direct access to a common EHR system. – Providing the patient with direct access to their EHR medication information through a patient portal. 164
CodingInstructions  CodeA2122B/A2124B, Health Information Exchange (HIE), – If your agency participates in a Health Information Exchange (HIE) and used the HIE to electronically exchange the current reconciled medication list with the subsequent provider, patient, family, and/or caregiver. 165
Coding Instructions  CodeA2122C/A2124C, Verbal, if: – The current reconciled medication list information was verbally communicated to the subsequent provider, patient, family, and/or caregiver.  CodeA2122D/A2124D, Paper-Based, if: – The current reconciled medication list was transmitted to the subsequent provider, patient, family, and/or caregiver using a paper-based method. 166
Coding Instructions  CodeA2122E/A2124E, Other Methods, if: – The current reconciled medication list was transmitted to the subsequent provider, patient, family, and/or caregiver using another method, not listed above.  Dash is not a valid response for this item. 167
168
169
B0200.Hearing 170
Coding Instructions  Code 0,Adequate, when the patient has no difficulty hearing: – In normal conversation. – In social interaction. – Listening to TV. 171
CodingInstructions  Code 1, Minimal difficulty, when the patient: – Has difficulty in some environments. – Hears speech at conversational levels but has difficulty hearing when not in quiet listening conditions or when not in one-on-one situations. – The patient’s hearing is adequate after environmental adjustments are made. 172
CodingInstructions  Code 2, Moderate difficulty, if: – Speaker has to increase volume and speak distinctly.Although hearing deficient, the patient compensates when the speaker adjusts tonal quality and speaks distinctly; or – The patient can hear only when the speaker’s face is clearly visible. 173
CodingInstructions  Code 3, Highly impaired, if: – Absence of useful hearing. – The patient hears only some sounds and frequently fails to respond even when the speaker adjusts tonal quality, speaks distinctly, or is positioned face-to-face. – There is no comprehension of conversational speech, even when the speaker makes maximum adjustments.  Dash is a valid response when coding this item. – Adash indicates “no information.” – CMS expects dash use to be a rare occurrence. 174
175
B1000.Vision 176
B1000.Vision  The intent of this item is to identify the patient’s ability to see objects nearby: – In their environment. – In adequate light. – With glasses or With other visual appliances. 177
 Ask the patient, family, caregivers and/or staff, if possible, about the patient’s usual vision patterns.  Ensure that the patient’s customary visual appliance for close vision is in place (e.g., eyeglasses, magnifying glass).  Ensure adequate lighting. 178 Response-SpecificInstructions
Definition  Adequate Lighting: – Lighting that is sufficient or comfortable for a person with normal vision to see fine detail. 179
Coding Instructions  Code 0,Adequate, if : – The patient sees fine detail, including regular print in newspapers/books.  Code 1, Impaired, if: – The patient sees large print, But not regular print in newspapers/books.  Code 2, Moderately impaired, if the patient: – Has limited vision, – Is not able to see newspaper headlines but – Can identify objects nearby in their environment. 180
CodingInstructions  Code 3, Highly impaired, if the patient’s: – Ability to identify objects nearby in their environment is in question, but – Eye movements appear to be following objects.  Code 4, Severely impaired, if the patient: – Has no vision. – Sees only light, colors or shapes. – Does not appear to follow objects with eyes. 181
 If the patient is unable to communicate or follow your directions for testing vision, observe the patient’s eye movements to see if their eyes seem to follow movement and objects. – Though these are gross measurements of visual acuity, they may assist you in assessing whether or not the patient has any visual ability. – For patients who appear to follow movement and objects, code “3, highly impaired.” 182 CodingTips
183
B1300.HealthLiteracy  The intent of this item is to identify the patient’s self-reported health literacy. 184
 Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. 185 HealthLiteracyDefinition
 Note: – This item is intended to be a patient self-report item. – No other source should be used to identify the response.  Ask the patient, – “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?” 186 Coding Instructions
 Complete this item: – As close to the time of SOC/ROC as possible, and – Within three days of discharge. 187 Coding Instructions-Timepoint
CodingInstructions Code 0, Never, if the patient indicates never needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. Code 1, Rarely, if the patient indicates rarely needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. Code 2, Sometimes, if the patient indicates sometimes needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. 188
CodingInstructions  Code 3, Often, if the patient indicates often needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies.  Code 4, Always, if the patient indicates always needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. 189
CodingInstructions  Code 7, Patient declines to respond, if the patient declines to respond.  Code 8, Patient unable to respond, if the patient is unable to respond.  Dash is not a valid response for this item. 190
191
SectionC- CognitivePatterns  This section contains guidance for nine items that assess cognitive function including: – The Brief Interview for Mental Status (BIMS); and – Signs and Symptoms of Delirium from CAM©. 192
New itemsin SectionC  New items include: – C0100: Should Brief Interview for Mental Status (C0200-C0500) be Conducted? – C0200-C0500: Brief Interview for Mental Status (BIMS). – C01310: Signs and Symptoms of Delirium (from CAM©). 193
Existing items in Section C  Existing items in this section include: – M1700- Cognitive Functioning. – M1710- When Confused. – M1720- WhenAnxious. 194
New Item-Section C C0100- ShouldBriefInterviewfor MentalStatusbeConducted? 195
C0100.ShouldBriefInterviewforMentalStatus beConducted?  The intent of this item is to identify if the Brief Interview for Mental Status (BIMS) should be conducted. 196
 Interact with the patient using their preferred language. – Be sure the patient: • Can hear you, and/or • Has access to their preferred method for communication. – If the patient appears unable to communicate, offer alternatives. 197 Response-SpecificInstructions
Coding Instructions Code 0, No, if the interview should not be conducted because: – The patient is rarely/never understood. – The patient cannot respond verbally, in writing, or using another method. – An interpreter is needed but not available.  If code “0. No” Skip items C0200-C0500. 198
CodingInstructions  Code 1,Yes, if the interview should be conducted because: – The patient is at least sometimes understood verbally, in writing, or using another method, and – If an interpreter is needed, and one is available.  If code “1,Yes” Proceed to C0200, Repetition of Three Words.  Dash is a valid response for this item. 199
200
C0200- RepetitionofThreeWords 201
C0300: TemporalOrientation 202
C0400: Recall 203
C0500: BIMSSummaryScore 204
Intent  The intent of this item is to determine the patient’s: – Attention. – Orientation. – Ability to register and recall information. 205
Nonsensical Response is any response that is: – Unrelated. – Incomprehensible. – Incoherent. – It is not informative with respect to the item being rated. 206 Definition of Nonsensical
The BIMS interview is considered complete if: – The patient attempted and provided relevant answers to at least four of the questions included in C0200-C0400C. 207 Definition of Complete Interview
 Interview any patient not screened out by item C0100 (Should Brief Interview for Mental Status Be Conducted?)  Conduct the interview in a private setting, if possible. – Patients with visual impairment should be tested using their usual visual aids. – Sit so that the patient can see your face. – Minimize glare by directing light sources away from the patient’s face and from written materials. – Be sure the patient can hear you. 208 BasicInterviewInstructionsforBIMS (C0200-C0500)Verballyandinwriting
Give an introduction or provide a written introduction, as appropriate before starting the interview. •Suggested language: “I would like to ask you some questions/ which I will show you in moment.We ask everyone these same questions. This will help us provide you with better care. Some of the questions may seem very easy, while others may be more difficult.” 209 BasicInterviewInstructionsforBIMS(C0200- C0500)Verballyandinwriting
If the patient expresses concern that you are testing their memory, they may be more comfortable if you reply: •“We ask these questions of everyone so we can make sure that our care will meet your needs.” 210 BasicInterviewInstructionsforBIMS (C0200-C0500)Verballyandinwriting
 Directly ask the written questions, each item in C0200 through C0400 at one sitting and in the order provided.  If the patient chooses not to answer a particular item, accept their refusal and move on to the next questions. • For C0200 through C0400, code refusals as incorrect/no answer or could not recall. 211 BasicInterviewInstructionsforBIMS(C0200- C0500)Verballyandinwriting
 For C0200 items, instructions should be written as follow: – “I have written 3 words for you to remember. Please read them. Then I will remove the card and ask you repeat or write down the words as you remember them.” 212 InstructionsforBIMSwhenAdministered inWriting
 Category cues should be provided to the patient in writing after the patient’s first attempt to answer.  Written category cues should state: – Sock, something to wear; – Blue, a color; – Bed, a piece of furniture. 213 Instructionsfor BIMSwhen AdministeredinWriting
 For C0300 items, instructions should be written as: – C0300A: “Please tell me what year it is right now.” – C0300B: “What month are we in right now?” – C0300C: “What day of the week is today?” 214 Instructionsfor BIMSwhen AdministeredinWriting
For C0400 items, instructions should be written as: – “Let’s go back to an earlier question. What were those three words that I asked you to repeat?” 215 InstructionsforBIMSwhenAdministered inWriting
 If the patient is unable to remember a word, provide Category cues again, but without using the actual word. Therefore, Category cues for: 1. C0400Ashould be written as “something to wear,” 2. C0400B should be written as “a color,” and 3. C0500C should be written as “a piece of furniture.” 216 InstructionsforBIMSwhenAdministered inWriting
Coding Instructions  If SOC/ROC assessment; – Collect as close to the time of SOC/ROC as possible.  If discharge assessment, – Complete as close to the time of discharge as possible.  Dash is a valid response for this item. – Adash indicates “no information”. – CMS expects dash use to be a rare occurrence. 217
Codingtips  Code “0” is used to represent three types of responses: 1. Incorrect answers. 2. Nonsensical responses. 3. Questions the patient chooses not to answer. 218
RulesforStoppingtheBIMsInterview  Rules for stopping the BIMS interview before it is complete: – Stop the interview after completing (C0300C) “Day of the Week” if: • All responses have been nonsensical OR • There has been no verbal or written response to any of the questions up to this point, OR • There has been no verbal or written response to some questions up to this point and for all others, the patient has given a nonsensical response. 219
Codingtips  If the interview is stopped, do the following: – Code “-” (dash) in C0400A, C0400B, and C0400C. – Code 99 in the summary score in C0500. 220
CueCards for BIMS Written Introduction Card – BIMS – Items C0200-C0400 221 I would like to ask you some questions, which I will show you in a moment. We ask everyone these same questions.This will help us provide you with bettercare. Some of the questions may seem very easy, while others may be more difficult. We ask these questions so that we can make sure that our care will meet yourneeds.
WrittenInstructionCards–ItemC0200– RepetitionofThreeWords 222 I have written 3 words for you to remember. Please read them. Then, I will remove the card and ask you to repeat or write down the words as you remember them.
WordCards – ItemC0200 223
CategoryCue Cards –ItemC0200 224
WrittenInstructionCards–ItemC0300–Temporal OrientationStatementCard-C0300A-Year 225
QuestionCards–ItemC0300B-Month 226 What month are we in right now?
QuestionCards–ItemC0300C-Day 227
WrittenInstructionCards–ItemC0400-Recall 228
CategoryCueCards–ItemC0400A-Sock 229
CategoryCueCards–ItemC0400B-Blue 230
CategoryCueCards–ItemC0400C-Bed 231
232
C0200- Repetitionof ThreeWords 233
Category Cue define as: –Phrase that puts a word in context to help with learning and to serve as a hint that helps prompt the patient. –The category cue for sock is “something to wear.” –The category cue for blue is “a color”. –The category for bed, is “a piece of furniture.” 234 Definition
For C0200: Repetition of Three Words: – Tell patient: “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are; sock, blue, and bed.” 235 C0200- Repetitionof ThreeWords
– Immediately after presenting the three words, say to the patient: “Now please tell me the three words.” – After the patient’s first attempt to repeat the items: • If the patient correctly stated all three words, say, “That’s right, The words are sock, something to wear; Blue, a color; and Bed, a piece of furniture” 236 C0200- Repetitionof ThreeWords
 After the patient’s first attempt to repeat the items: – If the patient recalled two or fewer words, code C0200, Repetition ofThree words according to the patient’s recall on this first attempt. – Next say to the patient: “Let me say the three words again. They are: • Sock, something to wear; • Blue, a color; and • Bed, a piece of furniture. • Now tell me the three words.” 237 C0200- Repetitionof ThreeWords
– If the patient still does not recall all three words correctly, you may repeat the words and category cues one more time. – Do not code the number of repeated words on the second or third attempt.  Record the maximum number of words that the patient correctly repeated on the first attempt.  This will be any number between “0” and “3.” 238 C0200- Repetitionof ThreeWords
Coding Instructions  Code “0, none” if : – The patient did not repeat any of the 3 words on the first attempt.  Code “1, one” if : – The patient repeated only 1 of the 3 words on the first attempt.  Code “2, two” if: – The patient repeated only 2 of the 3 words on the first attempt.  Code “3, three” if: – The patient repeated all 3 words on the first attempt.  Dash is a valid response for this item. 239
240
C0300: TemporalOrientation 241
Temporal Orientation – Is the ability to place oneself in correct time. – For the BIMS, it is the ability to indicate the correct date in current surroundings. 242 Definition
For C0300 (A, B, and C) - Temporal Orientation: – Ask the patient each of the 3 questions in Item C0300 separately. – Allow the patient up to 30 seconds for each answer and do not provide clues. 243 Response-SpecificInstructions
244
WrittenInstructionCards–ItemC0300–Temporal OrientationStatementCard-C0300A-Year 245
C0300: TemporalOrientation 246
CodingInstructionsforC0300A-Ableto reportCorrectyear  Code 0, missed by > 5 years or no answer, if: – The patient’s answer is incorrect and is greater than 5 years from the current year; Or – The patient chooses not to answer the item, Or – The answer is nonsensical. 247
CodingInstructionsforC0300A-Ableto reportCorrectyear  Code 1, missed by 2-5 years, if: – The patient’s answer is incorrect and is within 2 to 5 years from the current year.  Code 2, Missed by 1 year, if : – The patient’s answer is incorrect and is within one year from the current year. 248
CodingInstructionsforC0300A-Ableto reportCorrectyear  Code 3, correct, if : – The patient states the correct year.  Dash is a valid response for this item. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 249
250
QuestionCards–ItemC0300B-Month 251 What month are we in right now?
C0300: TemporalOrientation 252
CodingInstructionsfor C0300B- Able toreportCorrectMonth  Count the current day as day 1 when determining whether the response was accurate: – Within 5 days, or – Missed by 6 days to 1 month. 253
CodingInstructionsforC0300B-Ableto reportCorrectMonth Code 0, missed by >1 month or no answer, if : – The patient’s answer is incorrect by more than 1 month; or – The patient chooses not to answer the item, or – The answer is nonsensical. 254
CodingInstructionsforC0300B-Ableto reportCorrectMonth  Code 1, missed by 6 days to 1 month, if: – The patient’s answer is accurate within 6 days to 1 month.  Code 2, accurate within 5 days, if: – The patient’s answer is accurate within 5 days.  Dash is a valid response for this item. 255
256
QuestionCards–ItemC0300C-Day 257
C0300: TemporalOrientation 258
CodingInstructionsforC0300C-Ableto reportCorrectDayoftheWeek  Code 0, incorrect, or no answer, if : – The answer is incorrect, or – The patient chooses not to answer the item, or – The answer is nonsensical.  Code 1, correct, if: – The answer is correct. 259
260
C0400: Recall 261
 For C0400 (A, B, and C): Recall: – Ask the patient the following: “Let’s go back to an earlier question. What were those three words that I asked you to repeat?” 262 Response-SpecificInstructions
WrittenInstructionCards–ItemC0400-Recall 263
 For C0400 (A, B, and C): Recall: – Allow up to 5 seconds for spontaneous recall of each word. – For any word that is not correctly recalled after 5 seconds, provide the category cue used in C0200. – Category cues should be used only after the patient is unable to recall one or more of the three words. – Allow up to 5 seconds after category cueing for each missed word to be recalled. 264 Response-SpecificInstructions
CategoryCueCards–ItemC0400A-Sock 265
CategoryCueCards–ItemC0400B-Blue 266
CategoryCueCards–ItemC0400C-Bed 267
CodingInstructionsfor C0400A-C Code 0, no - could not recall, if: – The patient cannot recall the word even after being given the category cue; Or – If the patient responds with a nonsensical answer; Or – Chooses not to answer the item. 268
Coding Instructionsfor C0400A-C  Code 1, yes, after cueing, if: – The patient requires the category cue to remember the word.  Code 2, yes, no cue required, if: – The patient correctly remembers the word spontaneously without cueing.  Dash is a valid response for this item. 269
CodingTips  If on the first try, the patient names multiple items in a category, one of which is correct, they should be coded as correct for that item.  If, however, the assessing clinician gives the patient the cue and the patient then names multiple items in that category, the item is coded as could not recall, even if the correct item was in the list. 270
271
C0500: BIMS SummaryScore 272
 Scores from a carefully conducted BIMS assessment where patients can hear all questions and the patient is not delirious suggest the following: – 13-15: Cognitively intact – 8-12: Moderately impaired – 0-7: Severe impairment 273 ItemRational
Coding Instructions  Enter the total score as a two-digit number.  The total possible BIMS score ranges from “00” to “15.” – If the patient chooses not to answer a specific question(s): • That question is coded as incorrect, and the item(s) counts in the total score. • If, however, the patient chooses not to answer four or more items, then the interview is coded as incomplete. 274
Coding Instructions(cont.)  To be considered a completed interview, the patient had to attempt and provide relevant answers to at least four of the questions included in C0200-C0400C. 275
CodingInstructions  Code 99, unable to complete interview, if; (a) The patient chooses not to participate in the BIMS. (b)Four or more items were coded “0” because the patient chose not to answer or gave a nonsensical response, or (c) Any of the BIMS items is coded with a “-” (dash). 276
CodingTips  Occasionally, a patient can communicate but chooses not to participate in the BIMS and therefore does not attempt any of the items in the section.  This would be considered an incomplete interview; enter code “99” for C0500. 277
278
C1310- SignsandSymptomsofDelirium 279
C1310- SignsandSymptomsof Delirium The intent of this item is to identify any signs or symptoms of acute mental status changes as compared to the patient’s baseline status. 280
 Delirium is a mental disturbance characterized by: – New or acutely worsening confusion. – Disorder expression of thoughts. – Change in level of consciousness, or – Hallucinations. 281 Definition-Delirium
 Examples of acute mental status changes include: – Apatient who is usually noisy or belligerent becomes quiet, lethargic, or inattentive. – Apatient who is normally quiet and content suddenly becomes restless or noisy. – Apatient who is usually able to find their way around their living environment begins to get lost. 282 ExamplesofAcuteMentalStatusChanges
Fluctuation: – The behavior tends to come and go and/or Increase or decrease in severity. – The behavior may fluctuate over the course of the interview or during the assessment period. – Fluctuating behavior may be noted by: • The assessing clinician, • Reported by staff or family, or • Documented in the medical record. 283 Definition-Fluctuation
C1310A,AcuteMentalStatus Change 284
CodingInstructionsforC1310A,AcuteMental StatusChange  Code 0, no, if: – There is no evidence of acute mental status change from the patient’s baseline.  Code 1, yes, if: – Patient has an alteration in mental status observed or reported or identified that represents an acute change from baseline.  Dash is a valid response for this item. 285
C1310B, Inattention 286
Inattention: – Reduced ability to maintain attention to external Stimuli and to appropriately shift attention to new external stimuli. – Patient seems unaware or out of touch with environment (e.g., dazed. Fixated or darting attention). 287 Definition-Inattention
Coding Instructionsfor C1310B, Inattention  Code 0, behavior not present, if: – The patient remains focused during the assessment,And – All other sources agree that the patient was attentive during other activities. 288
CodingInstructionsforC1310B,Inattention  Code 1, behaviorcontinuously present, does not fluctuate, if : – The patient had difficulty focusing attention, – The patient was easily distracted, or – The patient had difficulty keeping track of what was said, and – The inattention did not vary.  All sources must agree that inattention was consistently present to select this code. 289
CodingInstructionsforC1310B,Inattention  Code 2, behaviorpresent, fluctuates, if inattention is noted during the assessment or any source reports that: – The patient had difficulty focusing attention, – The patient was easily distracted, or – The patient had difficulty keeping track of what was said, and – The inattention varied, or – If information sources disagree in assessing level of attention. 290
CodingInstructionsforC1310B,Inattention  Dash is a valid response for this item. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 291
292 C1310C-Disorganized Thinking
Disorganized Thinking evidenced by: – Rambling, – Irrelevant, or – Incoherent speech. 293 Definition-Disorganized Thinking
CodingInstructionsforC1310C, DisorganizedThinking Code 0, behavior not present, if: – All sources agree that the patient’s thinking was organized and coherent, even if answers were inaccurate or wrong. 294
CodingInstructionsforC1310C, DisorganizedThinking  Code 1, behavior continuously present, does not fluctuate, if during the assessment and according to other sources: – The patient’s responses were Consistently disorganized or incoherent. – Conversation was rambling or irrelevant, – Ideas were unclear or flowed illogically, or – The patient unpredictably switched from subject to subject. 295
CodingInstructionsfor C1310C, DisorganizedThinking  Code 2, behavior present, fluctuates, if during the assessment or according to other data sources, the patient’s responses: – Fluctuated between disorganized/incoherent and organized/clear. – Also, code as fluctuating if information sources disagree. 296
297 C1310D-AlteredLevelofConsciousness
AlteredLevelof Consciousness Vigilant Startles easilytoany soundor touch Lethargic Repeatedlydoze offwhenyouare askingquestions butrespondsto voiceortouch Comatose Stupor Verydifficultto arouseandkeep arousedforthe interview 298 Cannotbe arouseddespite shakingand shouting
CodingInstructionsforC1310D, AlteredLevelofConsciousness  Code 0, behavior not present, if: –All sources agree that the patient was alert and maintained wakefulness during conversation, interview(s), and activities. 299
CodingInstructionsforC1310D, AlteredLevelofConsciousness  Code 1, behaviorcontinuously present, does not fluctuate, if during the assessment and according to other sources, the patient was consistently; – Lethargic, – Stuporous, – Vigilant, or – Comatose. 300
CodingInstructionsforC1310D, AlteredLevelofConsciousness  Code 2, behaviorpresent, fluctuates, if: – During the assessment or according to other sources, the patient’s level of consciousness varied. – For example, the patient was at times alert and responsive, while at other times the patient was lethargic, stuporous, or vigilant. – Code as fluctuating if information sources disagree. 301
C1310A, C1310B,C1310C and C1310D  Dash is a valid response for these items. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 302
303
304
305 OR and either
306 OR
307
SectionD  New items in this sections are included: – D0150- Patient Mood Interview (PHQ-2 to PHQ-9) – D0160- Total Severity Score. – D0700- Social Isolation. 308
309
NEW-D0150-PatientMoodInterview (PHQ-2toPHQ-9) 310
NEW-D0150-PatientMoodInterview (PHQ-2toPHQ-9) 311 PHQ-2 PHQ-9 Theremaining7questions
 Patient Health Questionnaire (PHQ-2 to PHQ- 9): – Avalidated interview that screens for symptoms of depression. – It provides a standardized severity score and a rating for evidence of a depressive disorder. 312 Definition
 If the patient appears unable to communicate, offer alternatives such as: – Writing, – Pointing, – Sign language, or – Cue cards. 313 Response-SpecificInstructions
 If an interpreter is used during patient interviews, the interpreter should not attempt to determine: – The intent behind what is being translated, – The outcome of the interview, or – The meaning or significance of the patient’s responses. 314 Response-SpecificInstructions
315 CueCard 0-1 (Never or 1 day) 2-6 days (several days) 7-11 days (half or more days) 12-14 days (nearly every day)
NEW-D0150-PatientMoodInterview (PHQ-2toPHQ-9) 316
For each of the questions: – Read the item as it is written. – Do not provide definitions. – Each question must be asked in sequence to assess presence (column 1) and frequency (column 2) before proceeding to the next question. 317 Response-SpecificInstructions
 Enter code “9” if : – The patient was unable to complete the interview. – Chose not to complete the interview. – Responded nonsensically, and/or – The agency was unable to complete the assessment.  If Column 1 coded 9, Leave Column 2, Symptom Frequency, blank. 318 CodingInstructionsforColumn1: SymptomPresence
319 Response-SpecificInstructions
320 Response-SpecificInstructions If the patient rarely/never understood 1. Code D0150A1 & D0150B1 “9.” 2. Leave D0150A2 and D0150B2 blank. 3. End the PHQ-2 Interview. 4. Skip to D0160.
321 Response-SpecificInstructions  If both D0150A2 and D0150B2 are less than 2. 1. There is no need to continue to the PHQ-9. 2. End the PHQ-2, and 3. Enter the total score from D0150A2 and D0150B2 in D0160 (Total Severity Score).
322 Response-SpecificInstructions  If both D0150A2 and D0150B2 are Blank: 1. End the PHQ-2, and 2. Skip D0160.
323 Response-SpecificInstructions  If both D0150A2 and D0150B2 are Coded 9: 1. Leave D0150A2 and D0150B2 Blank, then 2. End the PHQ-2, and 3. Skip D0160.
324 Response-SpecificInstructions  If either D0150A2 or D0150B2 are 2 or 3: 1.Complete the PHQ-9. 2.Proceed to ask the remaining seven questions (D0150C to D0150I) of the PHQ-9, and 3.Complete D0160 (Total Severity Score).
325 Response-SpecificInstructions  If D0150A2 is 0 or 1, and  D0150B2 is 2 or 3: 1.Complete the PHQ-9. 2.Proceed to ask the remaining seven questions (D0150C to D0150I) of the PHQ-9, and 3.Complete D0160 (Total Severity Score).
326 Response-SpecificInstructions  If D0150A2 is 2 or 3, and  D0150B2 is 0 or 1: 1.Complete the PHQ-9. 2.Proceed to ask the remaining seven questions (D0150C to D0150I) of the PHQ-9, and 3.Complete D0160 (Total Severity Score).
327 D0150:Column1.SymptomPresence. CodingInstructions
CodingInstructionsforColumn1:SymptomPresence 328
CodingInstructionsforColumn1:SymptomPresence 329
CodingInstructionsforColumn1: SymptomPresence  Code 0, no: if: – Patient indicates symptoms listed are not present. – Enter 0 in Column 2 as well.  Code 1, yes: if: – Patient indicates symptom listed is present. – Enter 0, or 1, 2, or 3 in Column 2, Symptom Frequency. 330
 Enter code “9” if : – The patient was unable to complete the interview. – Chose not to complete the interview. – Responded nonsensically, and/or – The agency was unable to complete the assessment.  If Column 1 was coded 9, Leave Column 2, Symptom Frequency, blank. 331 CodingInstructionsforColumn1: SymptomPresence
Dash is a valid response for this item. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 332 CodingInstructionsforColumn1: SymptomPresence
CodingInstructionsforColumn2:SymptomFrequency 333
Coding Instructionsfor Column2: SymptomFrequency  Code 0, never or 1 day, if: – The patient indicates that during the past 2 weeks: • They have never been bothered by the symptom, or • They have only been bothered by the symptom on 1 day. 334
CodingInstructionsforColumn2: SymptomFrequency  Code 1, 2-6 days (several days), if: – The patient indicates that during the past 2 weeks, they have been bothered by the symptom for 2-6 days.  Code 2, 7-11 days (half or more of the days), if: – The patient indicates that during the past 2 weeks, they have been bothered by the symptom for 7-11 days. 335
CodingInstructionsfor Column2: SymptomFrequency  Code 3, 12-14 days (nearly every day), if: – The patient indicates that during the past 2 weeks, they have been bothered by the symptom for 12-14 days.  Dash is a valid response for this item. 336
337 CodingTips  If the patient has difficulty selecting between two frequency responses:  Code for the higher frequency.
338 CodingTips  If Column 1 equals 0,  Enter 0 in Column 2  If Column 1 equals 9,  Leave Column 2 blank
339 CodingTips  If the patient describes the presence of a symptom, but cannot quantify a frequency:  Code the presence of the symptom as “1:Yes” in Column 1, and  Enter a dash in Column 2.
340 CodingTips  If a patient gives different frequencies for the different parts of a single item:  Select the highest frequency as the score for that item.
CodingTips  Patients may respond to questions: – Verbally, – By pointing to their answers on the cue card, or – By writing out their answers 341
InterviewingTips and Techniques If the patient has difficulty selecting a frequency response, start by offering a single frequency response and follow with a sequence of more specific questions. This is known as Unfolding. 342
InterviewingTips and Techniques Patients may be reluctant to report symptoms and should be gently encouraged to tell you if the symptom bothered them, even if it was only some of the time. This is known as Probing. 343
InterviewingTips and Techniques  To narrow the answer to the response choices available, it can be useful to summarize their longer answer and then ask them which response option best applies.  This is known as Echoing. 344
InterviewingTips and Techniques  If the patient has difficulty with longer items, separate the item into shorter parts, and provide a chance to respond after each part.  This method, known as Disentangling. 345
346
D0160- Total SeverityScore  The intent of this item is to identify the severity score calculated from responses to the PHQ-2 to PHQ-9. 347
348 ScoringRules
ScoringRules The maximum patient score for the Patient Mood Interview Total Severity Score D0160 is 27 (3x9). The Total Severity Score will be: – Between 00 and 27, or – “99” if symptom frequency is blank for three or more items. 349
350 Response-SpecificInstructions  If both D0150A2 and D0150B2 are Coded 9: 1. Leave D0150A2 and D0150B2 Blank, then 2. End the PHQ-2, and 3. Skip D0160.
351 Response-SpecificInstructions  If no assessment is conducted for Symptom Presence: 1. Enter a dash (-) in Column 1, 2. Skip Column 2 in each row of D0150A-I, then 3. Code 99 for D0160.
ScoringRules-Column1and 2 If only the PHQ-2 is completed because both D0150A2 and D0150B2 are less than 2 then: 352 Add the numeric scores from these two frequency items and Enter the value in D0160.
ScoringRules-Column1and 2 If the PHQ-9 was completed; and If the patient answered the frequency responses of at least 7 of the 9 items on the PHQ- 9: 353  Add the numeric scores from D0150A2-D0150I2, and  Enter that number in D0160 Total Severity Score.
EXAMPLE 354
ScoringRules-Column1and 2  If symptom frequency in items D0150A2 through D0150I2 is blank for 3 or more items: 355  The interview is NOT complete.  Total Severity Score should be coded as “99.”
EXAMPLE 356
CodingTips  Responses to PHQ-2 to 9 can be interpreted as follows: – Major Depressive Syndrome is suggested if-- of the 9 items: • 5 or more items are identified at a frequency of half or more of the days (7-11 days) during the look-back period. 357
CodingTips – Minor Depressive Syndrome is suggested if of the 9 items, the following items are identified at a frequency of half or more of the days (7-11 days) during the look- back period: 1)D0150B- Feeling down, depressed or hopeless, 2)D0150C- Trouble falling or staying asleep, or sleeping too much, or 3)D0150D- Feeling tired or having little energy. 358
CodingTips  Total Severity Score can be interpreted as follows: 359 Score Interpretation 0-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately sever depression 20-27 Severe depression
ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  The score in item D0160 is based upon the sum of the values that are contained in the following nine items: –D0150A2, –D0150B2, –D0150C2, –D0150D2, –D0150E2, –D0150F2, –D0150G2, –D0150H2, –D0150I2. 360
RulesHowtoComputetheScoreforitem D0160  These rules consider the "number of missing items in Column 2" which is the number of items in Column 2 that are either skipped or are equal to dash. – An item in Column 2 is skipped if the corresponding item in Column 1 was equal to 9. – An item in Column 2 could be equal to dash if the item could not be assessed for some other reason. 361
ScoringRules: PatientMoodInterview TotalSeverityScoreD0160  If all of the items in Column 2 have a value of 0, 1, 2, or 3 then: 362  Item D0160 is equal to the simple sum of those values.
ScoringRules: PatientMoodInterview TotalSeverityScoreD0160  If any of the items in Column 2 are skipped or equal to dash, then 363  Omit their values when computing the sum.
ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  If the number of missing items in Column 2 is equal to one, then: 364 1.Compute the simple sum of the eight items in Column 2 that have non-missing values, 2.Multiply the sum by 9/8 (1.125), and 3.Place the result rounded to the nearest integer in item D0160.
ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  If the number of missing items in Column 2 is equal to two, then: 365 1. Compute the simple sum of the seven items in Column 2 that have non-missing values, 2. Multiply the sum by 9/7 (1.286), and 3. Place the result rounded to the nearest integer in item D0160.
ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  If the number of missing items in Column 2 is equal to three or more, then 366  Item D0160 must equal to “99.”
367
D0700- SocialIsolation-New  The intent of this item is to identify the patient’s actual or perceived lack of contact with other people, such as living alone or residing in a remote area. 368
Definitionof SocialIsolation  Social isolation refers to an actual or perceived lack of contact with other people, such as: – Living alone, or – Residing in a remote area. 369
Response –specific Instructions  This item is intended to be a patient self-report item.  No other source should be used to identify the response.  Ask the patient “How often do you feel lonely or isolated from those around you?”  Complete as close to the time of SOC/ROC and DC as possible. 370
Coding Instructions  Code 0, Never, if the patient indicates never feeling lonely or isolated from others.  Code 1, Rarely, if the patient indicates rarely feeling lonely or isolated from others.  Code 2, Sometimes, if the patient indicates sometimes feeling lonely or isolated from others.  Code 3, Often, if the patient indicates often feeling lonely or isolated from others. 371
Coding Instructions  Code 4,Always, if the patient indicates always feeling lonely or isolated from others.  Code 7, Patient declines to respond, if the patient declines to respond.  Code 8, Patient unable to respond, if the patient is unable to respond.  Dash is not a valid response for this item. 372
373
374
375 GG0100:PriorFunctioningItemRevisions
 Code 3, Independent, If the patient completed ALLthe activities by themselves with or without an assistive device, with no assistance from a helper.  Code 2, Needed Some Help, if the patient needed partial assistance from another person to complete Any of the activities.  Code 1, Dependent, if the helper complete ALL the activities for the patient, or the assistance of two or more helpers was required for the patient to complete then activities. 376 GG0100:PriorFunctioningItemRevisions(cont.)
 Code 8, Unknown, if the patient’s usual ability prior to the current illness, exacerbation, or injury is unknown.  Code 9, NotApplicable, if the activities were not applicable to the patient prior to the current illness, exacerbation, or injury. 377 GG0100:PriorFunctioningItemRevisions(cont.)
 For GG0100-Prior Functioning: EverydayActivities: – Report the patient’s functional ability prior to the onset of the current illness, exacerbation of a chronic condition, or injury, whichever is most recent, that initiated this episode of care. – Completing the stair activity for GG0100C. Stairs indicates that a patient went up and down the stairs, by any safe means, with or without handrails or assistive devices or equipment, and/or with or without some level of assistance. 378 GG0100:PriorFunctioningCodingTips
379
380 GG0110: PriorDeviceUse
 For GG110. Prior Device Use: – Report the devices used by the patient prior to the onset of the current illness, exacerbation of a chronic condition, or injury, whichever is more recent, that initiated this episode of care. – For the response category in this item, CMS does not provide an exhaustive list of assistive devices that may used when coding prior device use. – Devices may have been used indoors and/or outdoors. 381 GG0110: PriorDeviceUse(cont.)
 GG0110C, Prior Devices: Mechanical lift Includes any mechanical device or equipment a patient or caregiver requires for lifting or supporting the patient’s bodyweight. 382 GG0110:PriorDeviceUseUpdate/revision
 Examples include, but are not limited to: – Stair lift, – Hoyer – Bathtub lift, – Sit-to-stand lift, – Stand assist, – Electric recliner, and – Full-body style lifts, if required.  Clinical judgment may be used to determine whether other devices meet the mechanical lift definition provided. 383 GG0110:PriorDeviceUseUpdate/revision(cont.)
 GG0110D, Walker refers to all types of walkers. Examples include, but are not limited to, – Pick-up walkers, – Hemi-walkers, – Rolling walkers, and – Platform walkers. 384 GG0110:PriorDeviceUseUpdate/revision(cont.)
 Code Z, None of the above, if the patient did not use any of the listed devices or aids immediately prior to the current illness, exacerbation, or injury.  Dash is a valid response for this item. –Dash indicates “no information.” –CMS expects dash use to be a rare occurrence. 385 GG0110:PriorDeviceUseUpdate/revision (cont.)
386
 Licensed clinician may assess the patient’s self-care and mobility performance based on:  Direct observation (preferred),  Patient/caregiver report,  Assessment of similar activities, and/or  Collaboration with other agency staff who have had direct contact with the patient, or  Some other means of gathering information. 387 RevisedGeneralResponseSpecificInstructions forGG0130/GG0170
 Guidanceonhowtocodeanactivitywhenonlyaportionof theactivityhasbeencompleted:  If the patient only completes a portion of the activity and does not complete the entire activity during the assessment time frame, use clinical judgment to determine if the situation allows the clinician to adequately assess the patient’s ability to complete the activity. 388 (New) General ResponseSpecific Instructionsfor GG0130/GG0170
 If the clinician determines that this observation is adequate, code based on the type and amount of assistance the patient requires to complete the Entire activity.  If the clinician determines the partial activity does not provide adequate information to support determination of a performance code, select an appropriate“Activity not attempted” code. 389 (New)GeneralResponseSpecific InstructionsforGG0130/GG0170(cont.)
 When a function activity is not completed entirely during one clinical observation, code based on the type and amount of assistance required to complete the entire activity. 390 (New)GeneralResponseSpecific InstructionsforGG0130/GG0170(cont.)
The time period under consideration is the look-back period to use when coding each OASIS item.  For most items, the look-back is the Day of Assessment.  For other items, the look-back period is different, such as “in the last 14 days” or “at the time of or since the most recent SOC/ROC.” 391 TimingDefinitionforGG0130/GG0170
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PP for HHA providers

  • 2. ImportantNotice  This training is current as of the date of this presentation.  Information in this training is not intended to be all inclusive and is not a substitute for current regulations, Center for Medicare and Medicaid Services (CMS) publications, and/or instructions outlined in the current OASIS Guidance Manual, and Update Memorandum. 2
  • 3. Objective  Describe the Standardized of the assessments in the PostAcute Care (PAC) setting.  Describe current use of OASIS item set.  Describe the reason for data accuracy.  Identify the revised and New items on OASIS-E item set effective January 01, 2023.  Describe the general OASIS item conventions for completing OASIS.  Identify coding instructions and tips for new and updated items. 3
  • 4. The current uses for OASIS include: 1) Home HealthAgency Medicare-Certification Surveys. 2) The quality measures on the consumer-focused Care Compare website. 3) The quality measures used in the Home Health Quality of Patient Care Star Ratings. 4) The quality measures used in the CMS Home Health Value- Based Purchasing (HHVBP) Model. 4 Overview
  • 5. 5) The QualityAssessment Only (QAO) Metric used in home health pay-for- reporting (P4R). 6) The OASIS instrument also plays a pivotal role in post- acute care quality improvement related to the mandates of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACTAct). 7) Production of quality reports for agencies, 8) Determining reimbursement under Medicare Prospective Payment System (PPS). 5 Overview (cont.)
  • 6.  Regulatory language stipulates that the encoded OASIS data must accurately reflect the patient’s status at the time the information is collected.  The State survey process for HHAs may include review of OASIS data collected versus data encoded and transmitted to the CMS. 6 DataAccuracy
  • 7.  Processes to promote data accuracy may include: – Clinical record audits. – Data entry audits. – Reports produced from electronic health record systems or other activities. 7 DataAccuracy
  • 8. ImprovingMedicarePost-AcuteCare TransformationACT(IMPACTACT)  The Improving Medicare Post-Acute Care TransformationAct (IMPACTAct) of 2014, enacted October 6, 2014.  ThisAct directs the Secretary of Health and Human Services (HHS) to “specify quality measures on which Post-Acute Care (PAC) providers are required under the applicable reporting provisions to submit standardized patient assessment data” in several quality measure domains. 8
  • 10. ImprovingMedicarePost-AcuteCare TransformationACT(IMPACTACT)  The collection of data in a standardized manner facilitate: – Outcome comparison. – Data interoperability. – Comparison of quality within and between PAC settings. – Improve Medicare beneficiary outcomes through: • Shared decision making. • Care Coordination. • Enhanced discharge planning. 10
  • 11. Implementationof theOASIS-E  These changes will become effective on January 1st, 2023, with OASIS-E. 11
  • 13. Changes fromOASIS-D toOASIS-E  OASIS-E reflects revisions based on proposals finalized in the: – CalendarYear (CY) 2019 Home Health (HH) Final Rule effective January 1, 2020, and – CY2022 HH Final Rule effective January 1, 2023. 13
  • 14. Changes fromOASIS-D to OASIS-E  Main reason to revise the OASIS is: – To increase standardization across post-acute (PAC) setting to uniformly collect Social Determination Of Health (SDOH) data. – To enable calculation of standardized, cross- setting Quality Measure (QMs). – Pursuant to the provisions of the Improving Medicare Post-Acute Care Transformation (IMPACT)Act. 14
  • 15. Changes fromOASIS-D toOASIS-E  With OASIS-E, effective January 1, 2023, the items that were made optional with OASIS-D1 were removed from the specified time points. – M2016 – Patient/Caregiver Drug Education Intervention was also removed from the OASIS instrument. – OASIS-E includes the addition of certain Standardized Patient Assessment Data Elements including those addressing certain Social Determinants of Health (SDOH). 15
  • 16. 16
  • 17. NochangesontheseOASISitems 17 SectionA.AdministrativeInformation:PatientTracking OASIS-E Item # OASIS-D Item # Item Description M0018 M0018 NationalProviderIdentifier(NPI) M0010 M0010 CMSCertificationNumber M0014 M0014 BranchState M0016 M0016 BranchIDNumber M0020 M0020 PatientIDNumber M0030 M0030 StartofCareDate M0032 M0032 ResumptionofCareDate M0040 M0040 PatientName M0050 M0050 PatientStateofResidence
  • 18. NochangesontheseOASISitems 18 SectionA.AdministrativeInformation:PatientTracking OASIS-E Item # OASIS-D Item # Item Description M0060 M0060 PatientZipCode M0063 M0063 MedicareNumber M0064 M0064 SocialSecurityNumber M0065 M0065 MedicaidNumber M0069 M0069 Gender M0066 M0066 BirthDate M0150 M0150 CurrentPaymentSourcefor HomeCare
  • 19. NochangesontheseOASISitems 19 SectionA.AdministrativeInformation OASIS-E Item # OASIS-D Item # Item Description M0080 M0080 DisciplineofPersonCompletingAssessment M0090 M0090 DateAssessmentCompleted M0110 M0110 EpisodeTiming M0906 M0906 Discharge/Transfer/DeathDate M1005 M1005 InpatientDischargeDate M2310 M2310 ReasonforEmergentCare M2410 M2410 TowhichInpatientFacilityhasthepatientbeen admitted M0104 M0104 DateofReferral
  • 20. NochangesontheseOASISitems 20 SectionC.CognitivePatterns OASIS-E Item # OASIS-D Item # Item Description M1700 M1700 CognitiveFunctioning M1710 M1710 WhenConfused M1740 M1740 Cognitive,Behavioral,andPsychiatric Symptoms M1745 M1745 FrequencyofDisruptiveBehavior Symptoms M1720 M1720 WhenAnxious SectionE.Behavior
  • 21. NochangesontheseOASISitems 21 SectionF.PreferencesforCustomaryRoutine OASIS-E Item # OASIS-D Item # Item Description M1100 M1100 PatientLivingSituation M2102 M2102 TypesandSourcesofAssistance
  • 22. Nochanges on theseOASISitems 22 SectionG.FunctionalStatus OASIS-E Item # OASIS-D Item # Item Description M1810 M1810 CurrentAbilitytoDressUpperBody M1820 M1820 CurrentAbilitytoDressLowerBody M1840 M1840 ToiletTransferring M1845 M1845 ToiletingHygiene M1850 M1850 Transferring M1860 M1860 Ambulation/Locomotion M1830 M1830 Bathing
  • 23. NochangesontheseOASISitems 23 OASIS-E Item # OASIS-D Item # Item Description M1600 M1600 Hasthispatientbeentreatedfora UrinaryTractInfectioninthepast 14days? SectionH.BladderandBowel SectionGG.FunctionalAbilities&Goals GG0110 GG0110 PriorDeviceUse
  • 24. Nochanges on theseOASISitems 24 OASIS-E Item # OASIS-D Item # Item Description J1900 J1900 NumberofFalls SectionJ.HealthConditions M1028 M1028 ActiveDiagnoses–Comorbidities andCo-existingConditions SectionI.ActiveDiagnoses
  • 25. Nochanges on theseOASISitems 25 OASIS-E Item # OASIS-D Item # Item Description M1060 M1060 HeightandWeight SectionK.Swallowing/NutritionalStatus M1870 M1870 FeedingorEating SectionM.SkinConditions M1307 M1307 OldestStage2PressureUlcer
  • 26. NochangesontheseOASISitems 26 OASIS-E Item # OASIS-D Item # Item Description M2003 M2003 MedicationFollow-up M2010 M2010 Patient/CaregiverHigh-RiskDrug Education M2020 M2020 ManagementofOralMedications M2005 M2005 MedicationIntervention SectionN.Medications
  • 27. Nochanges on theseOASISitems 27 OASIS-E Item # OASIS-D Item # Item Description M1046 M1046 InfluenzaVaccineReceived SectionO.SpecialTreatments,Procedures,andPrograms
  • 28. 28
  • 29. OASISItemsremoved 29 OASIS-D Item # Item Description Item/InstructionChange Description M0140 Race/Ethnicity Removed SectionA.AdministrativeInformation:PatientTracking M1200 Vision Removed SectionB.Hearing,Speech,Vision
  • 30. OASISItemsremoved 30 OASIS-D Item # Item Description Item/InstructionChange Description M1730 Depression Screening Removed M1910 Fall RiskAssessment Removed SectionG.FunctionalStatus SectionD.Mood
  • 31. OASIS Itemsremoved 31 OASIS-D Item # Item Description Item/InstructionChange Description M1242 FrequencyofPainInterfere withActivity/movement Removed SectionJ-HealthConditions SectionK.Swallowing/NutritionalStatus M1030 Therapiesthepatientreceivesathome Removed
  • 32. OASISItemsremoved 32 OASIS-D Item # Item Description Item/InstructionChange Description M2016 Patient/CaregiverDrug EducationIntervention Removed M1051 PneumococcalVaccine Removed M1056 ReasonPneumococcalVaccine notreceived Removed SectionN.Medications SectionO.SpecialTreatments,Procedures,andPrograms
  • 33. 33
  • 34. OASISItems-SkipTextRemoved/updated OASIS-E OASIS-D ItemDescription NewItem Item Text Skip Pattern Item/InstructionChange Description 34 SectionA.AdministrativeInformation M0100 M0100 This assessment is currently Being completed for the Following reason X Skip Text removed M0102 M0102 DateofPhysician-OrderedStartof Care(ResumptionofCare) X X Skip text updated M1000 M1000 InpatientFacilities X X Skiptextupdated M2301 M2301 EmergentCare X Skiptextupdated M2420 M2420 DischargeDisposition X Skiptextadded
  • 35. OASISItems-SkipTextRemoved/updated OASIS-E OASIS- D Item Description NewItem Item Text Skip Pattern Item/InstructionChange Description 35 SectionJ.HealthConditions J1800 J1800 AnyFallsSinceSOC/ROC X Skiptextupdated M1330 M1330 StasisUlcer Skip text updated SectionM.SkinConditions M1306 M130 6 UnhealedPressureUlcer/Injury atStage2orHigher Skiptextupdated M1311 M1311 CurrentNumberofUnhealed PressureUlcers/InjuriesatEachStage Skiptextupdated M1340 M1340 SurgicalWound X Skip text updated
  • 36. OASISItems-SkipTextRemoved/updated OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 36 SectionN.Medications M2001 M2001 DrugRegimenReview Skiptextupdated M1041 M1041 InfluenzaVaccineData CollectionPeriod X Skiptextupdated SectionO.SpecialTreatments,Procedures,andPrograms
  • 37. 37
  • 38. TextEdit OASIS-E OASIS-D Item Description NewItem ItemText Skip Pattern Item/InstructionChange Description 38 SectionA.AdministrativeInformation M0102 M0102 Date of Physician-Ordered Start of Care (Resumption of Care) X X Text edit:  NA response updated to include ROC  Skip text updated M1000 M1000 Date of Physician-Ordered Start of Care (Resumption of Care) X X Text edit:  Mark all that apply” is replaced with “Check all that apply”  Skip text updated
  • 39. TextEdit OASIS-E OASIS-D ItemDescription New Item Item Text Skip Pattern Item/InstructionChangeDescription 39 SectionGG.FunctionalAbilities&Goals GG0100 GG0100 PriorFunctioning: EverydayActivities X Text edits:  “all” added to code options 3 – Independent and 1 – Dependent  “any” added to code option 2 – Needed Some Help  “Him/herself” changed to “themself.”  GG0100A, Self Care, reworded to read "...using the toilet, and eating prior...”
  • 40. TextEdit OASIS-E OASIS-D ItemDescription New Item ItemText Skip Pattern Item/InstructionChangeDescription 40 SectionGG.FunctionalAbilities&Goals GG0130 GG0130 Self-Care X Text edits:  GG0130B,Oralhygiene; “removeandreplace”changed to“insertandremove”inSOC, ROC,andAllItemsversions  Codinginstructions: “Him/herself”changedto “themself.”
  • 41. TextEdit OASIS-E OASIS-D ItemDescription New Item Item Text Skip Pattern Item/InstructionChangeDescription 41 SectionGG.FunctionalAbilities&Goals GG0170 GG0170 Mobility X X Text edits:  GG0170C, Lying to sitting; “Feet flat on the floor” phrase removed  GG0170M, 1 step, reworded to read “...curb or up and down one step”  Coding instructions: “him/herself” changed to “themself.”
  • 42. TextEdit OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 42 SectionH.BladderandBowel M1620 M1620 BowelIncontinenceFrequency X Textedit:  “Omit‘UK’optionon FU”textremoved  No,longercollectedatFU M2401 M2401 InterventionSynopsis X Textedit:  RowA-Diabeticfootcare removed SectionQ.ParticipationinAssessmentandGoalSetting
  • 43. 43
  • 44. NotCollectedatFU OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 44 SectionH.BladderandBowel M1610 M1610 UrinaryIncontinenceor UrinaryCatheterPresence NolongercollectedatFU M1630 M1630 OstomyforBowelElimination NolongercollectedatFU M1021 M1021 PrimaryDiagnosis NolongercollectedatFU M1023 M1023 OtherDiagnoses NolongercollectedatFU SectionI.ActiveDiagnoses M1620 M1620 BowelIncontinenceFrequency NolongercollectedatFU
  • 45. NotCollectedatFU OASIS-E OASIS- D ItemDescription New Item Item Text Skip Patter n Item/InstructionChange Description 45 SectionM.SkinConditions J1330 J1330 StasisUlcer No longer collected at FU M1324 M1324 StageofMostProblematicUnhealed PressureUlcerthatisStageable No longer collected at FU M1322 M1322 CurrentNumberof stageIPressure Injuries No longer collected at FU M1311 M1311 CurrentNumberofUnhealed PressureUlcers/InjuriesatEachStage No longer collected at FU
  • 46. NotCollectedatFU OASIS-E OASIS-D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 46 SectionM.SkinConditions J1332 J1332 CurrentNumberof StasisUlcers Observable No longer collected at FU J1334 J1334 StatusofMostProblematicStasis UlcerObservable No longer collected at FU J1340 J1340 SurgicalWound X No longer collected at FU J1342 J1342 StatusofMostProblematic SurgicalWoundObservable No longer collected at FU
  • 47. NotCollectedatFU OASIS-E OASIS- D ItemDescription NewItem ItemText Skip Pattern Item/InstructionChange Description 47 SectionJ.HealthConditions M1400 M1400 WhenispatientdyspneicorSOB? No longer collected at FU Section N. Medications M2030 M2030 ManagementofInjectable Medications No longer collected at FU SectionO.SpecialTreatments,Procedures,andPrograms M2200 M2200 TherapyNeed(#visits) No longer collected at FU
  • 49. Addto Follow-up OASIS-E OASIS-D Item Description NewItem ItemText Skip Pattern Item/InstructionChange Description 49 SectionG.FunctionalStatus M1800 M1800 Grooming AddedtoFU(with OASIS-D1) M1033 M1033 RiskforHospitalization AddedtoFU(with OASIS-D1) SectionJ.HealthConditions
  • 50. 50
  • 51. New SocialDeterminationsOf Health (SDOH) Items New SDOH items for HHA: – A1005- Ethnicity – A1010- Race – A1100- Language – A1250- Transportation – B1300- Health Literacy – D0700- Social Isolation 51
  • 52. New Non-SDOH Items  New Non- SDOH items for HHA: – A2120-A2124- Transfer of Health information. – B0200- Hearing – B1000- Vision 52
  • 53. New Items 53 SectionA.AdministrativeInformation:PatientTracking OASIS-E ItemDescription NewItem Item/InstructionChange Description A1005 Ethnicity X M1010 Race X
  • 54. NewItems 54 SectionA.AdministrativeInformation OASIS-E Item Description NewItem Item/Instruction ChangeDescription A1110 Language X A1250 Transportation X A2120 ProvisionofCurrentReconciledMedicationListto SubsequentProvideratTransfer X A2121 ProvisionofCurrentReconciledMedicationListto SubsequentProvideratDischarge X
  • 56. NewItems 56 SectionB.Hearing,Speech,Vision OASIS-E Item Description NewItem Item/InstructionChange Description B0200 Hearing X B1000 Vision X Note:  B1000Visionisanewitem ReplacingM1200Vision B1300 HealthLiteracy X
  • 57. NewItems 57 SectionC.CognitivePatterns OASIS-E Item Description NewItem Item/InstructionChange Description C0100 ShouldBriefInterviewforMentalStatus(C0200- C0500)beConducted X C0200 RepetitionofThreeWords X C0300 TemporalOrientation X C0400 Recall X C0500 BIMSSummaryScore X C1310 SignsandSymptomsofDelirium(fromCAMŠ) X
  • 58. NewItems 58 SectionD.Mood OASIS-E Item Description NewItem Item/InstructionChangeDescription D0150 PatientMoodInterview(PHQ 2-9) X Note:  D0150PatientMood Interview(PHQ2-9)isa newitem  ReplacingM1730 DepressionScreening
  • 59. New Items 59 SectionD.Mood(cont.) OASIS-E Item Description NewItem Item/InstructionChangeDescription D0160 TotalSeverityScore X D0700 SocialIsolation X
  • 60. NewItems 60 SectionJ.HealthConditions OASIS-E ItemDescription New Item Item/InstructionChangeDescription J0510 Pain Effect on Sleep X Note: J0510 Pain Effect on Sleep is a new item Replacing M1242 Frequency of Pain Interfering
  • 62. NewItems 62 SectionJ.HealthConditions(cont.) OASIS-E ItemDescription NewItem Item/InstructionChangeDescription J0530 Pain Interference with Day-to-DayActivities X Note:  J0530 Pain Interference with Day-to-DayActivities is a new item  Replacing M1242 Frequency of Pain Interfering
  • 63. NewItems 63 SectionK.Swallowing/NutritionalStatus OASIS-E Item Description NewItem Item/InstructionChangeDescription SectionN.Medications K0520 NutritionalApproaches X N0415 HighRiskDrugClasses:Use andIndication X
  • 65. 65
  • 66. M2420-DischargeDisposition  Guidance modifying the definition of “formal assistive services” M2420 – Discharge Disposition was updated to support new Transfer of Health Quality Measures:  Code 2, Patient remained in the community (with formal assistive services), now applies if, – After discharge from your agency the patient remained in a non-inpatient setting, receiving skilled services from another Medicare certified home health agency, or – When an agency completes a discharge and new SOC OASIS due to a pay source change for a patient. 66
  • 67. Non-PhysicianPractitioners Guidance was updated related to allowing orders to be received from select non-physician practitioners, as it impacts OASIS items where the presence of a physician’s order affects the item coding:  Section 3708 of the CoronavirusAid, Relief, and Economic Security (CARES)Act amended section 1861(aa)(5) of theAct, allowing nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) to certify eligibility and provide orders for home health services, where not prohibited by State Law.  Accordingly, when coding OASIS items where the presence of a physician’s order affects the item coding, orders from these allowed practitioners would satisfy the condition of having a physician’s order. 67
  • 68. M0102–Dateofphysician-orderedSOC/ROC  The date specified by a physician/allowed practitioner order to start home care services or resume home care services regardless of the type of services ordered.  When coding OASIS items where the presence of a physician’s order affects the item coding, orders from an allowed practitioner including physician assistant, nurse practitioner, or other advanced practice nurse would satisfy the condition of having a physician’s order. 68
  • 69. M0104 –Dateofreferral  A valid referral is considered received when the agency has received adequate information about a patient to initiate patient assessment and confirmed that the referring physician/allowed practitioner or another physician/allowed practitioner, will provide the plan of care (POC)and ongoing orders. 69
  • 70. M1021-Primarydiagnosis,and M1023–Other diagnoses:  The assessing clinician determine the primary and other home health diagnoses based on the assessment findings, information in the medical record including but not limited to: – Physician/non-physician practitioner orders, – Medication list and referral information, and, – Input from the physician/nonphysician practitioner. 70
  • 71. OASIS data collection  OASIS data are collected for: – Skilled Medicare and Medicaid patients. – Patients 18 years and older. 71
  • 72. Whoexcludedfor OASIS data collectionandsubmission?  OASIS data collection and submission are excluded for: – Patients receiving services for pre- or postnatal conditions. – Those receiving only: o Personal care. o Homemaker. o Chore services. 72
  • 73. OASISandtheComprehensiveAssessment  The comprehensive assessment including OASIS, if applicable, completed by one clinician.  If collaboration with other health care personnel and/or agency staff is utilized, the agency is responsible for establishing policies and practices related to collaborative efforts, including how assessment information from multiple clinicians will be documented within the clinical record, ensuring compliance with applicable requirements, and accepted standards of practice. 73
  • 74. TimePoints 74 Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Start of care (SOC) 1.Start of care – further visits planned Within 5 calendar days after the SOC date (SOC = Day 0) Resumptionofcare (ROC) 3. Resumptionofcare(after inpatientstay) Within2calendardaysof:  Thefacilitydischargedateor  Knowledgeofpatient’s returnhome
  • 75. TimePoints 75 Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Follow-up (FU) 4.Recertification (follow-up) assessment Thelast5daysofevery60 days. i.e.,days56-60ofthecurrent 60-dayperiod. 5. Other follow-up Within 2 calendar days of significant change of patient’s condition.
  • 76. Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Transfer to an Inpatient Facility (TRN) TimePoints 76 6. Transferredtoaninpatient facility–patientnot dischargedfromagency Within2calendardaysof:  Discharge/trans/deathdateor  Knowledgeofaqualifying transfertoinpatientfacility. 7. Transferred to an inpatient facility – patient discharged from agency Within2calendardaysof:  Discharge/trans/deathdateor  Knowledgeofaqualifying transfertoinpatientfacility.
  • 77. TimePoints 77 Time Point Reason forAssessment (RFA, M0100) Assessment Timeframe Discharge from Agency – not to an inpatient facility (DC) 8. Death at home (DAH) Within 2 calendar days of Discharge/Transfer/Death date 9. Discharge from agency (DC) Within 2 calendar days of Discharge/Transfer/Death date.
  • 78. WhoCompletesOASIS  M0080 (Discipline of Person CompletingAssessment) indicated the comprehensive Start of Care (SOC) assessment including OASIS data collection, if applicable, is the responsibility of: – ARegistered Nurse (RN) in cases involving nursing services. – The Physical Therapist (PT), Speech Language Pathologist/ Speech Therapist (SLP/ST), For a Medicare therapy-only case, conduct SOC comprehensive assessment including OASIS. 78
  • 79. Who CompletesOASIS (cont.) – Effective January 1, 2022, Occupational Therapist (O.T.) may conduct the SOC comprehensive assessments including OASIS for Medicare patients when the physician’s referral order does not include skilled nursing, but does include PTand/or SLP, along with OT. – Any discipline qualified to perform OASIS assessments (RN, PT, SLP, OT) may complete subsequent OASIS assessments (e.g., transfers, recertifications, resumptions of care, discharge) after the SOC. 79
  • 80. WhoEstablishMedicareeligibility  Services which establish eligibility for the Medicare home health benefit include: – Skilled Nursing (SN), – PhysicalTherapy (P.T.) – Speech Language Pathology (SLP).  OT does not establish the initial eligibility for the HH benefit. 80
  • 81. Who cannot CompletesOASIS  The following staff may NOT be responsible for completing the comprehensive assessment and OASIS: – ALicensed Practical Nurse or LicensedVocational Nurse (LPN/LVN), – PhysicalTherapistAssistant (PTA), – OccupationalTherapyAssistant (OTA), – Medical SocialWorker (MSW), – Home HealthAide (HHa). 81
  • 82. WhoCompletesOASIS  Multidisciplinary cases may have multiple points of discipline-specific discharge, though there is only one HHAdischarge, which must include completion of the comprehensive discharge assessment including OASIS if applicable. 82
  • 83. General OASIS ItemConventions 1. Understand the time period under consideration (look back) for each item.  Report what is true on the day of assessment unless a different time period has been indicated in the item or related guidance. 83
  • 84. DayofAssessment  Day of assessment is defined as: – The 24 hours immediately preceding the home visit; and – The time spent by the clinician in the home. 84
  • 85. GeneralOASISItemConventions 2. For OASIS purposes, in order to be considered a complete quality episode, a quality episode must have: – Abeginning. And – Aconclusion. 85
  • 86. GeneralOASIS ItemConventions 3.If the patient’s ability or status varies on the day of the assessment, report the patient’s “usual status” or what is true greater than 50% of the time period under consideration, unless the item specifies differently. 4.Minimize the use of “NA” and “Unknown responses.” 86
  • 87. GeneralOASIS ItemConventions 5. Some items allow a dash response.  Adash (–) value indicates that no information is available.  CMS expects dash use to be a rare occurrence. 87
  • 88. GeneralOASIS ItemConventions 6. Responses to items documenting a patient’s current status should be based on observation and report of the patient’s condition and ability at the time of the assessment without referring back to prior assessments or documentation of status from a prior care setting. 88
  • 89. General OASIS ItemConventions 7. Assessment strategies to complete any and all OASIS items include the following, unless otherwise noted in guidance: – Observation. – Interview. – Collaboration with other agency staff. – Other relevant strategies. 89
  • 90. GeneralOASIS ItemConventions 8. When an OASIS item refers to assistance, this means assistance from another person. 9. Complete OASIS items accurately and comprehensively and adhere to skip patterns. 10. Understand the definitions of words as used in the OASIS. 11. Follow rules included in the item-specific Guidance. 90
  • 91. General OASIS ItemConventions 12. Stay current with evolving CMS OASIS guidance via updates to the guidance manual and posted Q&Adocuments. 13. The comprehensive assessment includes the OASIS items and is part of the patient’s legal home health agency clinical record. 14. While only the assessing clinician is responsible for accurately completing and signing a comprehensive assessment, they may collaborate to collect data for all OASIS items, if agency policy allows. 91
  • 92. GeneralOASIS ItemConventions 15.The use of the terms: – “Specifically,” means scoring of the item should be limited to only the circumstances listed.  “For example,” means the clinician may consider other relevant circumstances or attributes when scoring the item. 92
  • 93. Conventions Specific toOASIS M1800 ADL/IADLItems 1. Report the patient’s physical and cognitive ability to perform a task. Do not report on the patient’s preference or willingness to perform a specified task. 2. Understand what tasks are included and excluded in each item and select the OASIS response based only on included tasks. 93
  • 94. Conventions Specific toOASIS M1800 ADL/IADLItems 3. While the presence or absence of a caregiver may impact the way a patient carries out an activity, it does not impact the assessing clinician’s ability to assess the patient to determine and report the level of assistance the patient requires to safely complete a task. 94
  • 95. Conventions Specific toOASIS M1800 ADL/IADLItems 4. The level of ability refers to the level of assistance that the patient requires to safely complete a specified task. Assistance includes:  Verbal cues,  Reminders,  Supervision, and/or  stand-by or hands-on assistance. 95
  • 96. ConventionsSpecifictoOASISM1800 ADL/IADLItems 5. If the patient’s ability varies between the different tasks included in a multi-task item, report what is true in a majority of the included tasks, giving more weight to tasks that are more frequently performed. 6. Consider medical restrictions when determining ability. 96
  • 97. OASIS-ESections OASIS-E includes the following sections: 97 Section Title A Administrative Information • PatientTracking B Hearing, Speech, andVision C Cognitive Patterns D Mood E Behavior F Preferences for Customary RoutineActivities G Functional Status GG FunctionalAbilities and Goals
  • 98. OASIS-E Sections(cont.) OASIS-E includes the following sections: 98 Section Title H Bladder and Bowel I Active Diagnoses J Health Conditions K Swallowing/Nutritional Status M Skin Conditions N Medications O SpecialTreatments, Procedures and Programs Q Participation inAssessment and Goal Setting
  • 99. TimePointsfornewitems 99 Section Item Description SOC ROC FU TRN DC DAH A 1005 Ethnicity x A 1010 Race x A 1110 Language x A 1250 Transportation x x x A 2120 ProvisionofCurrentReconciled MedicationListtoSubsequent ProvideratTransfer X A 2121 ProvisionofCurrentReconciled MedicationListtoSubsequent ProvideratDischarge X
  • 100. TimePointsfornewitems 100 Section Item Description SOC ROC FU TRN DC DAH A 2122 RouteofCurrentReconciled MedicationListTransmission toSubsequentProvider X X A 2123 ProvisionofCurrent ReconciledMedicationListto PatientatDischarge X A 2124 RouteofCurrentReconciled MedicationListTransmission toPatient X
  • 101. TimePointsfornewitems 101 Section Item Description SOC ROC FU TRN DC DAH B 0200 Hearing x B 1000 Vision x B 1300 Health Literacy x x x
  • 102. TimePointsfornewitems 102 Section Item Description SOC ROC FU TRN DC DAH C 0100 ShouldBriefInterviewfor MentalStatus(C0200-C0500) be Conducted X X X C 0200 RepetitionofThreeWords X X X C 0300 TemporalOrientation X X X C 0400 Recall X X X C 0500 BIMSSummaryScore X X X C 1310 SignsandSymptomsof Delirium(fromCAMŠ) X X X
  • 103. TimePointsfornewitems 103 Section Item Description SOC ROC FU TRN DC DAH D 0150 PatientMoodInterview (PHQ2-9) X X X D 0160 Total Severity Score X X X D 0700 Social Isolation X X X J 0510 Pain Effect on Sleep X X X J 0520 PainInterferencewith TherapyActivities X X X J 0530 PainInterferencewithDay- to-DayActivities X X X
  • 104. TimePointsfornewitems 104 Section Item Description SOC ROC FU TRN DC DAH K 0520 NutritionalApproaches X X X N 0415 HighRiskDrugClasses: UseandIndication X X X O 0110 SpecialTreatments, Procedures,and Programs X X X
  • 105. 105
  • 106. 106
  • 107. 107
  • 110. A1005: EthnicityandA1010- Race  Note: These categories are NOT used to determine eligibility for participation in any Federal program. 110
  • 111. 111 A1005: EthnicityandA1010- Race Patient able to respond Patient unable to respond Patient declines to respond  Checkallthatapply  Checkbox(es)forindicatingethnicity/race categoriesidentifiesbythepatient.  Ifneitherthepatientnor aproxycanprovidea response,usemedical recorddocumentation.  Do not code base on a proxy response or medical record documentation  Aproxymay beused
  • 112. Codinginstructions A1005- Ethnicity&A1010-Race  Code X, Patient unable to respond: – If the patient is unable to respond. – If the response(s) is/are determined via proxy input, and/or medical record documentation, check all boxes that apply, including Code X - Patient unable to respond. – If the patient is unable to respond, and no other resources provided the necessary information, then only code “X – Patient unable to respond.” 112
  • 113. Codinginstructions A1005-Ethnicity&A1010-Race  CodeY(Patient declines to respond), in the case that the patient declines to respond. – Only code “Y– Patient declines to respond.” – Do not code base on a proxy input or medical record documentation.  Dash is not a valid response for these items (1005 and 1010). 113
  • 114. Codinginstructions-A1010:Race Code Z, None of the above, if: – The patient reports or it is determined from proxy or medical record documentation that none of the listed Races apply to the patient. 114
  • 115. 115
  • 116. A1110: Language- New Items The intent of this item is to identify the patient’s self-reported preferred language and need for an interpreter. 116
  • 118. Codinginstructions-A1110:Language  Enter the preferred language the patient primarily speaks or understands  Dash is a valid response for this item. – If the patient or any available source cannot or does not identify preferred language, enter a dash (“-“) in the first box. – Adash indicates “no information.” – CMS expects dash use to be a rare occurrence. 118
  • 119. Codinginstructions-A1110A:Language  Note: An organized system of signing, such as American Sign Language (ASL), can be reported as the preferred language if the patient needs or wants to communicate in this manner. 119
  • 121. Codinginstructions-A1110B:Language  Code 0, No, if the patient: – Indicates does not want or need of an interpreter to communicate with a doctor or health care staff.  Code 1,Yes, if the patient: – Indicates the need or want of an interpreter to communicate with a doctor or health care staff. 121
  • 122. Codinginstructions-A1110B:Language  Code 9, Unable to determine: – If no source can identify whether the patient needs or wants an interpreter.  Dash is not a valid response for this item. 122
  • 123. New Item (SDOH)- SectionA A1250: Transportation 123
  • 125. A1250:Transportation  The intent of this item is to identify access to transportation for ongoing health care and medication access.  Ask the patient: – “In the past six months to a year, has lack of transportation kept you from: • Medical appointments. • Getting your medications. • Non-medical meetings. • Appointments. • Work. • Getting things that you need?” 125
  • 126. Codinginstructions-A1250:Transportation CodeA,Yes:  If the patient indicates that lack of transportation has kept the patient from: – Medical appointments, or – Getting medications. 126
  • 127. Codinginstructions-A1250:Transportation Code B,Yes:  If the patient indicates that lack of transportation has kept the patient from: – Non-medical meetings, – Appointments, – Work, – Getting things that the patient needs. 127
  • 128. Codinginstructions-A1250:Transportation  Code C, No:  If the patient indicates that a lack of transportation has not kept the patient from: – Medical appointments, – Getting medications, – Non-medical meetings, – Appointments, – work, or – Getting things that the patient needs. 128
  • 129. Codinginstructions-A1250:Transportation  Code X, Patient unable to respond, if the patient is unable to respond.  In the cases where the patient is unable to respond, a response may be determined via proxy input. If a proxy is not able to provide a response, medical record documentation may be used.  If the response(s) is/are determined via proxy input and/or medical record documentation, check all boxes that apply, including Code X - Patient unable to respond.  If the patient is unable to respond and no other resources provided the necessary information, only code X – Patient unable to respond. 129
  • 130. Codinginstructions-A1250:Transportation CodeY, Patient declines to respond, if the patient declines to respond.  In the cases where the patient declines to respond, Code only “Y– Patient declines to respond.” Dash is not a valid response for this item. 130
  • 131. 131
  • 132. Important Terms  At the Time of Transfer or Discharge: – This is the period of time as close to the actual time of transfer or discharge as possible. – This time may be based on agency, State, or Federal guidelines for data collection at discharge. 132
  • 133. Important Terms (cont.)  Current Reconciled Medication List: – This refers to a list of the patient’s current medications at the time of discharge that was reconciled by the agency prior to the patient’s discharge. 133
  • 134. Definitions  Means of Providing a Current Reconciled Medication List: – Providing the current reconciled medication list at the time of transfer or discharge can be accomplished by any means, including: • Active means. • Passive means. 134
  • 135. 135
  • 138. A2120andA2121:ProvisionofCurrent ReconciledMedicationListtoSubsequentProvider atTransferandDischarge  The intent of these items is to identify if the home health agency provided a current reconciled medication list to the subsequent provider. 138
  • 139. Coding Instructions-A2120  For Home Health at Transfer: CompleteA2120 only if: – M0100,ThisAssessment is Currently Being Completed for the Following Reason: 6. Transferred to an inpatient facility – patient not discharged from agency. Or 7. Transferred to an inpatient facility – patient discharged from agency. 139
  • 140. Coding Instructions-A2121  For Home Health at Discharge: CompleteA2121 only if: – M0100, ThisAssessment is Currently Being Completed for the Following Reason: 9. Discharge fromAgency. And – M2420, Discharge Disposition is: 2. Patient remained in the community (with formal assistive services), Or 3. Patient transferred to a non-institutional hospice. 140
  • 141. Coding Instructions-A2120 &A2121  Code 0, No, if at transfer or discharge to a subsequent provider, your agency did not provide the patient’s current reconciled medication list to the subsequent provider.  Code 1,Yes, if at transfer or discharge to a subsequent provider, your agency did provide the patient’s current reconciled medication list to the subsequent provider. 141
  • 142. Coding Instructions  A2120 only: Code 2, NA, if: – At transfer to a subsequent provider, your agency was not made aware of the transfer timely and therefore, unable to provide the patient’s current reconciled medication list to the subsequent provider. Dash is not a valid response for this item. 142
  • 143. CodingTips (cont.)  At Transfer-Asubsequent provider is identified when the patient has transferred to any inpatient facility.  At Discharge –Asubsequent provider is identified when the patient has been discharged to home under the care of a home health agency or home hospice. 143
  • 144. CodingTips (cont.)  While the patient may receive care from other providers after discharge from your agency, these locations are not considered to be a subsequent provider for the purpose of coding this item.  Example of provider that are not considered as subsequent provider are: – Primary care providers. – Other outpatient providers. – Residential treatment centers. 144
  • 145. AdditionalConsiderationsforImportant MedicationListContent  Items that could be on a reconciled medication list include, but are not limited to: – Demographic information. – Allergies and/or adverse reactions. – Special instructions. – Purpose or indication for use. – Current prescribed and over-the-counter medications. 145
  • 146. ImportantMedicationListContent  Example of medications administered by any route at the time of discharge or transfer, that can be on a reconciled medication list but are not limited to: – Alist of the current prescribed medications. – Over-the-counter medications. – Nutritional supplements. – Vitamins, and/or homeopathic and herbal products. 146
  • 147. ImportantMedicationListContent(cont.) 1. Areconciled medication list could include important information about the patient including:  Their name.  Date of birth.  Active diagnoses.  Known medication.  Other allergies.  Known drug sensitivities and reactions. 147
  • 148. ImportantMedicationListContent(cont.) 2. Areconciled medication list could also include important information about each medication including:  The name of the medication.  Strength.  Dose.  Route of medication administration.  Frequency or timing.  Purpose/indication.  Any special instructions. 148
  • 149. ImportantMedicationListContent(cont.)  Documentation sources for reconciled medication list information include: – Electronic and/or – Paper records.  Examples of such records are: – Discharge summary records. – AMedicationAdministration Record. – An Intravenous MedicationAdministration Record. – Ahome medication list. – Physician orders. 149
  • 152. Intent of theA2123  The intent of this item is to identify if the home health agency provided a current reconciled medication list to the patient, family, and/or caregiver at discharge. 152
  • 153. Coding Instructions  ForHomeHealthatDischarge:CompleteA2123onlyif: – M0100,ThisAssessmentisCurrentlyBeingCompletedfortheFollowing Reason: 9. DischargefromAgency. And – M2420,DischargeDispositionis: 1. Patientremainedinthecommunity(withoutformalassistiveservices). Or 4. Unknown,becausepatientmovedtoageographiclocationnotservedby thisagency. Or – UK.Otherunknown. 153
  • 154. CodingInstructions Code 0, No, if at discharge to a home setting, your agency did not provide the patient’s current reconciled medication list to the patient, family, and/or caregiver. Code 1,Yes, if at discharge to a home setting, your agency did provide the patient’s current reconciled medication list to the patient, family, and/or caregiver. Dash is not a valid response for this item. 154
  • 155. Coding Instructions Patient/family/caregiver:  In order to code “1.Yes”, a current reconciled medication list was transferred.The recipient of the current reconciled medication list can be the: – Patient and/or – Afamily member and/or – Other caregivers. 155
  • 157. IntentofA2122andA2124  The intent of these items is to identify all routes used in the transmission of the current reconciled medication list to the subsequent provider at transfer or discharge or to the patient. 157
  • 160.  These items collect important data to monitor how medication lists are transmitted at transfer/discharge to the subsequent provider and at discharge to the patient, family, and caregiver.  The time points to complete these items are: – Transfer (A2122) – Discharge from agency (A2122 andA2124) 160 Item rational
  • 161. CodingInstructions For Home Health at Transfer, Complete A2122 only if:  M0100,ThisAssessment is Currently Being Completed for the Following Reason: 6. Transferred to an inpatient facility – patient not discharged from agency. Or 7. Transferred to an inpatient facility – patient discharged from agency. 161
  • 162. CodingInstructions For Home Health at Discharge, Complete A2122 only if:  M0100, ThisAssessment is Currently Being Completed for the Following Reason is: 9. Discharge fromAgency. And  M2420, Discharge Disposition is: 2. Patient remained in the community (with formal assistive services). Or 3. Patient transferred to a non-institutional hospice. .162
  • 163. CodingInstructions ForHomeHealthatDischarge completeA2124onlyif:  M0100,ThisAssessmentisCurrentlyBeingCompletedfortheFollowing Reason: 9. DischargefromAgency. And  M2420,DischargeDispositionis: 1. Patientremainedinthecommunity(withoutformalassistiveservices). Or 4. Unknown,becausepatientmovedtoageographiclocationnotservedby thisagency. Or • UK.Otherunknown. 163
  • 164. CodingInstructions CodeA2122A/A2124A, Electronic Health Record (EHR), if  Your agency has an EHR and used it to transmit or provide access to the reconciled medication list to the subsequent provider, patient, family, and/or caregiver. This would include: – Situations where both the discharging and receiving provider have direct access to a common EHR system. – Providing the patient with direct access to their EHR medication information through a patient portal. 164
  • 165. CodingInstructions  CodeA2122B/A2124B, Health Information Exchange (HIE), – If your agency participates in a Health Information Exchange (HIE) and used the HIE to electronically exchange the current reconciled medication list with the subsequent provider, patient, family, and/or caregiver. 165
  • 166. Coding Instructions  CodeA2122C/A2124C, Verbal, if: – The current reconciled medication list information was verbally communicated to the subsequent provider, patient, family, and/or caregiver.  CodeA2122D/A2124D, Paper-Based, if: – The current reconciled medication list was transmitted to the subsequent provider, patient, family, and/or caregiver using a paper-based method. 166
  • 167. Coding Instructions  CodeA2122E/A2124E, Other Methods, if: – The current reconciled medication list was transmitted to the subsequent provider, patient, family, and/or caregiver using another method, not listed above.  Dash is not a valid response for this item. 167
  • 168. 168
  • 169. 169
  • 171. Coding Instructions  Code 0,Adequate, when the patient has no difficulty hearing: – In normal conversation. – In social interaction. – Listening to TV. 171
  • 172. CodingInstructions  Code 1, Minimal difficulty, when the patient: – Has difficulty in some environments. – Hears speech at conversational levels but has difficulty hearing when not in quiet listening conditions or when not in one-on-one situations. – The patient’s hearing is adequate after environmental adjustments are made. 172
  • 173. CodingInstructions  Code 2, Moderate difficulty, if: – Speaker has to increase volume and speak distinctly.Although hearing deficient, the patient compensates when the speaker adjusts tonal quality and speaks distinctly; or – The patient can hear only when the speaker’s face is clearly visible. 173
  • 174. CodingInstructions  Code 3, Highly impaired, if: – Absence of useful hearing. – The patient hears only some sounds and frequently fails to respond even when the speaker adjusts tonal quality, speaks distinctly, or is positioned face-to-face. – There is no comprehension of conversational speech, even when the speaker makes maximum adjustments.  Dash is a valid response when coding this item. – Adash indicates “no information.” – CMS expects dash use to be a rare occurrence. 174
  • 175. 175
  • 177. B1000.Vision  The intent of this item is to identify the patient’s ability to see objects nearby: – In their environment. – In adequate light. – With glasses or With other visual appliances. 177
  • 178.  Ask the patient, family, caregivers and/or staff, if possible, about the patient’s usual vision patterns.  Ensure that the patient’s customary visual appliance for close vision is in place (e.g., eyeglasses, magnifying glass).  Ensure adequate lighting. 178 Response-SpecificInstructions
  • 179. Definition  Adequate Lighting: – Lighting that is sufficient or comfortable for a person with normal vision to see fine detail. 179
  • 180. Coding Instructions  Code 0,Adequate, if : – The patient sees fine detail, including regular print in newspapers/books.  Code 1, Impaired, if: – The patient sees large print, But not regular print in newspapers/books.  Code 2, Moderately impaired, if the patient: – Has limited vision, – Is not able to see newspaper headlines but – Can identify objects nearby in their environment. 180
  • 181. CodingInstructions  Code 3, Highly impaired, if the patient’s: – Ability to identify objects nearby in their environment is in question, but – Eye movements appear to be following objects.  Code 4, Severely impaired, if the patient: – Has no vision. – Sees only light, colors or shapes. – Does not appear to follow objects with eyes. 181
  • 182.  If the patient is unable to communicate or follow your directions for testing vision, observe the patient’s eye movements to see if their eyes seem to follow movement and objects. – Though these are gross measurements of visual acuity, they may assist you in assessing whether or not the patient has any visual ability. – For patients who appear to follow movement and objects, code “3, highly impaired.” 182 CodingTips
  • 183. 183
  • 184. B1300.HealthLiteracy  The intent of this item is to identify the patient’s self-reported health literacy. 184
  • 185.  Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. 185 HealthLiteracyDefinition
  • 186.  Note: – This item is intended to be a patient self-report item. – No other source should be used to identify the response.  Ask the patient, – “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?” 186 Coding Instructions
  • 187.  Complete this item: – As close to the time of SOC/ROC as possible, and – Within three days of discharge. 187 Coding Instructions-Timepoint
  • 188. CodingInstructions Code 0, Never, if the patient indicates never needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. Code 1, Rarely, if the patient indicates rarely needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. Code 2, Sometimes, if the patient indicates sometimes needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. 188
  • 189. CodingInstructions  Code 3, Often, if the patient indicates often needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies.  Code 4, Always, if the patient indicates always needing help reading instructions, pamphlets, or other written materials from doctors or pharmacies. 189
  • 190. CodingInstructions  Code 7, Patient declines to respond, if the patient declines to respond.  Code 8, Patient unable to respond, if the patient is unable to respond.  Dash is not a valid response for this item. 190
  • 191. 191
  • 192. SectionC- CognitivePatterns  This section contains guidance for nine items that assess cognitive function including: – The Brief Interview for Mental Status (BIMS); and – Signs and Symptoms of Delirium from CAMŠ. 192
  • 193. New itemsin SectionC  New items include: – C0100: Should Brief Interview for Mental Status (C0200-C0500) be Conducted? – C0200-C0500: Brief Interview for Mental Status (BIMS). – C01310: Signs and Symptoms of Delirium (from CAMŠ). 193
  • 194. Existing items in Section C  Existing items in this section include: – M1700- Cognitive Functioning. – M1710- When Confused. – M1720- WhenAnxious. 194
  • 195. New Item-Section C C0100- ShouldBriefInterviewfor MentalStatusbeConducted? 195
  • 196. C0100.ShouldBriefInterviewforMentalStatus beConducted?  The intent of this item is to identify if the Brief Interview for Mental Status (BIMS) should be conducted. 196
  • 197.  Interact with the patient using their preferred language. – Be sure the patient: • Can hear you, and/or • Has access to their preferred method for communication. – If the patient appears unable to communicate, offer alternatives. 197 Response-SpecificInstructions
  • 198. Coding Instructions Code 0, No, if the interview should not be conducted because: – The patient is rarely/never understood. – The patient cannot respond verbally, in writing, or using another method. – An interpreter is needed but not available.  If code “0. No” Skip items C0200-C0500. 198
  • 199. CodingInstructions  Code 1,Yes, if the interview should be conducted because: – The patient is at least sometimes understood verbally, in writing, or using another method, and – If an interpreter is needed, and one is available.  If code “1,Yes” Proceed to C0200, Repetition of Three Words.  Dash is a valid response for this item. 199
  • 200. 200
  • 205. Intent  The intent of this item is to determine the patient’s: – Attention. – Orientation. – Ability to register and recall information. 205
  • 206. Nonsensical Response is any response that is: – Unrelated. – Incomprehensible. – Incoherent. – It is not informative with respect to the item being rated. 206 Definition of Nonsensical
  • 207. The BIMS interview is considered complete if: – The patient attempted and provided relevant answers to at least four of the questions included in C0200-C0400C. 207 Definition of Complete Interview
  • 208.  Interview any patient not screened out by item C0100 (Should Brief Interview for Mental Status Be Conducted?)  Conduct the interview in a private setting, if possible. – Patients with visual impairment should be tested using their usual visual aids. – Sit so that the patient can see your face. – Minimize glare by directing light sources away from the patient’s face and from written materials. – Be sure the patient can hear you. 208 BasicInterviewInstructionsforBIMS (C0200-C0500)Verballyandinwriting
  • 209. Give an introduction or provide a written introduction, as appropriate before starting the interview. •Suggested language: “I would like to ask you some questions/ which I will show you in moment.We ask everyone these same questions. This will help us provide you with better care. Some of the questions may seem very easy, while others may be more difficult.” 209 BasicInterviewInstructionsforBIMS(C0200- C0500)Verballyandinwriting
  • 210. If the patient expresses concern that you are testing their memory, they may be more comfortable if you reply: •“We ask these questions of everyone so we can make sure that our care will meet your needs.” 210 BasicInterviewInstructionsforBIMS (C0200-C0500)Verballyandinwriting
  • 211.  Directly ask the written questions, each item in C0200 through C0400 at one sitting and in the order provided.  If the patient chooses not to answer a particular item, accept their refusal and move on to the next questions. • For C0200 through C0400, code refusals as incorrect/no answer or could not recall. 211 BasicInterviewInstructionsforBIMS(C0200- C0500)Verballyandinwriting
  • 212.  For C0200 items, instructions should be written as follow: – “I have written 3 words for you to remember. Please read them. Then I will remove the card and ask you repeat or write down the words as you remember them.” 212 InstructionsforBIMSwhenAdministered inWriting
  • 213.  Category cues should be provided to the patient in writing after the patient’s first attempt to answer.  Written category cues should state: – Sock, something to wear; – Blue, a color; – Bed, a piece of furniture. 213 Instructionsfor BIMSwhen AdministeredinWriting
  • 214.  For C0300 items, instructions should be written as: – C0300A: “Please tell me what year it is right now.” – C0300B: “What month are we in right now?” – C0300C: “What day of the week is today?” 214 Instructionsfor BIMSwhen AdministeredinWriting
  • 215. For C0400 items, instructions should be written as: – “Let’s go back to an earlier question. What were those three words that I asked you to repeat?” 215 InstructionsforBIMSwhenAdministered inWriting
  • 216.  If the patient is unable to remember a word, provide Category cues again, but without using the actual word. Therefore, Category cues for: 1. C0400Ashould be written as “something to wear,” 2. C0400B should be written as “a color,” and 3. C0500C should be written as “a piece of furniture.” 216 InstructionsforBIMSwhenAdministered inWriting
  • 217. Coding Instructions  If SOC/ROC assessment; – Collect as close to the time of SOC/ROC as possible.  If discharge assessment, – Complete as close to the time of discharge as possible.  Dash is a valid response for this item. – Adash indicates “no information”. – CMS expects dash use to be a rare occurrence. 217
  • 218. Codingtips  Code “0” is used to represent three types of responses: 1. Incorrect answers. 2. Nonsensical responses. 3. Questions the patient chooses not to answer. 218
  • 219. RulesforStoppingtheBIMsInterview  Rules for stopping the BIMS interview before it is complete: – Stop the interview after completing (C0300C) “Day of the Week” if: • All responses have been nonsensical OR • There has been no verbal or written response to any of the questions up to this point, OR • There has been no verbal or written response to some questions up to this point and for all others, the patient has given a nonsensical response. 219
  • 220. Codingtips  If the interview is stopped, do the following: – Code “-” (dash) in C0400A, C0400B, and C0400C. – Code 99 in the summary score in C0500. 220
  • 221. CueCards for BIMS Written Introduction Card – BIMS – Items C0200-C0400 221 I would like to ask you some questions, which I will show you in a moment. We ask everyone these same questions.This will help us provide you with bettercare. Some of the questions may seem very easy, while others may be more difficult. We ask these questions so that we can make sure that our care will meet yourneeds.
  • 222. WrittenInstructionCards–ItemC0200– RepetitionofThreeWords 222 I have written 3 words for you to remember. Please read them. Then, I will remove the card and ask you to repeat or write down the words as you remember them.
  • 232. 232
  • 234. Category Cue define as: –Phrase that puts a word in context to help with learning and to serve as a hint that helps prompt the patient. –The category cue for sock is “something to wear.” –The category cue for blue is “a color”. –The category for bed, is “a piece of furniture.” 234 Definition
  • 235. For C0200: Repetition of Three Words: – Tell patient: “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are; sock, blue, and bed.” 235 C0200- Repetitionof ThreeWords
  • 236. – Immediately after presenting the three words, say to the patient: “Now please tell me the three words.” – After the patient’s first attempt to repeat the items: • If the patient correctly stated all three words, say, “That’s right, The words are sock, something to wear; Blue, a color; and Bed, a piece of furniture” 236 C0200- Repetitionof ThreeWords
  • 237.  After the patient’s first attempt to repeat the items: – If the patient recalled two or fewer words, code C0200, Repetition ofThree words according to the patient’s recall on this first attempt. – Next say to the patient: “Let me say the three words again. They are: • Sock, something to wear; • Blue, a color; and • Bed, a piece of furniture. • Now tell me the three words.” 237 C0200- Repetitionof ThreeWords
  • 238. – If the patient still does not recall all three words correctly, you may repeat the words and category cues one more time. – Do not code the number of repeated words on the second or third attempt.  Record the maximum number of words that the patient correctly repeated on the first attempt.  This will be any number between “0” and “3.” 238 C0200- Repetitionof ThreeWords
  • 239. Coding Instructions  Code “0, none” if : – The patient did not repeat any of the 3 words on the first attempt.  Code “1, one” if : – The patient repeated only 1 of the 3 words on the first attempt.  Code “2, two” if: – The patient repeated only 2 of the 3 words on the first attempt.  Code “3, three” if: – The patient repeated all 3 words on the first attempt.  Dash is a valid response for this item. 239
  • 240. 240
  • 242. Temporal Orientation – Is the ability to place oneself in correct time. – For the BIMS, it is the ability to indicate the correct date in current surroundings. 242 Definition
  • 243. For C0300 (A, B, and C) - Temporal Orientation: – Ask the patient each of the 3 questions in Item C0300 separately. – Allow the patient up to 30 seconds for each answer and do not provide clues. 243 Response-SpecificInstructions
  • 244. 244
  • 247. CodingInstructionsforC0300A-Ableto reportCorrectyear  Code 0, missed by > 5 years or no answer, if: – The patient’s answer is incorrect and is greater than 5 years from the current year; Or – The patient chooses not to answer the item, Or – The answer is nonsensical. 247
  • 248. CodingInstructionsforC0300A-Ableto reportCorrectyear  Code 1, missed by 2-5 years, if: – The patient’s answer is incorrect and is within 2 to 5 years from the current year.  Code 2, Missed by 1 year, if : – The patient’s answer is incorrect and is within one year from the current year. 248
  • 249. CodingInstructionsforC0300A-Ableto reportCorrectyear  Code 3, correct, if : – The patient states the correct year.  Dash is a valid response for this item. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 249
  • 250. 250
  • 253. CodingInstructionsfor C0300B- Able toreportCorrectMonth  Count the current day as day 1 when determining whether the response was accurate: – Within 5 days, or – Missed by 6 days to 1 month. 253
  • 254. CodingInstructionsforC0300B-Ableto reportCorrectMonth Code 0, missed by >1 month or no answer, if : – The patient’s answer is incorrect by more than 1 month; or – The patient chooses not to answer the item, or – The answer is nonsensical. 254
  • 255. CodingInstructionsforC0300B-Ableto reportCorrectMonth  Code 1, missed by 6 days to 1 month, if: – The patient’s answer is accurate within 6 days to 1 month.  Code 2, accurate within 5 days, if: – The patient’s answer is accurate within 5 days.  Dash is a valid response for this item. 255
  • 256. 256
  • 259. CodingInstructionsforC0300C-Ableto reportCorrectDayoftheWeek  Code 0, incorrect, or no answer, if : – The answer is incorrect, or – The patient chooses not to answer the item, or – The answer is nonsensical.  Code 1, correct, if: – The answer is correct. 259
  • 260. 260
  • 262.  For C0400 (A, B, and C): Recall: – Ask the patient the following: “Let’s go back to an earlier question. What were those three words that I asked you to repeat?” 262 Response-SpecificInstructions
  • 264.  For C0400 (A, B, and C): Recall: – Allow up to 5 seconds for spontaneous recall of each word. – For any word that is not correctly recalled after 5 seconds, provide the category cue used in C0200. – Category cues should be used only after the patient is unable to recall one or more of the three words. – Allow up to 5 seconds after category cueing for each missed word to be recalled. 264 Response-SpecificInstructions
  • 268. CodingInstructionsfor C0400A-C Code 0, no - could not recall, if: – The patient cannot recall the word even after being given the category cue; Or – If the patient responds with a nonsensical answer; Or – Chooses not to answer the item. 268
  • 269. Coding Instructionsfor C0400A-C  Code 1, yes, after cueing, if: – The patient requires the category cue to remember the word.  Code 2, yes, no cue required, if: – The patient correctly remembers the word spontaneously without cueing.  Dash is a valid response for this item. 269
  • 270. CodingTips  If on the first try, the patient names multiple items in a category, one of which is correct, they should be coded as correct for that item.  If, however, the assessing clinician gives the patient the cue and the patient then names multiple items in that category, the item is coded as could not recall, even if the correct item was in the list. 270
  • 271. 271
  • 273.  Scores from a carefully conducted BIMS assessment where patients can hear all questions and the patient is not delirious suggest the following: – 13-15: Cognitively intact – 8-12: Moderately impaired – 0-7: Severe impairment 273 ItemRational
  • 274. Coding Instructions  Enter the total score as a two-digit number.  The total possible BIMS score ranges from “00” to “15.” – If the patient chooses not to answer a specific question(s): • That question is coded as incorrect, and the item(s) counts in the total score. • If, however, the patient chooses not to answer four or more items, then the interview is coded as incomplete. 274
  • 275. Coding Instructions(cont.)  To be considered a completed interview, the patient had to attempt and provide relevant answers to at least four of the questions included in C0200-C0400C. 275
  • 276. CodingInstructions  Code 99, unable to complete interview, if; (a) The patient chooses not to participate in the BIMS. (b)Four or more items were coded “0” because the patient chose not to answer or gave a nonsensical response, or (c) Any of the BIMS items is coded with a “-” (dash). 276
  • 277. CodingTips  Occasionally, a patient can communicate but chooses not to participate in the BIMS and therefore does not attempt any of the items in the section.  This would be considered an incomplete interview; enter code “99” for C0500. 277
  • 278. 278
  • 280. C1310- SignsandSymptomsof Delirium The intent of this item is to identify any signs or symptoms of acute mental status changes as compared to the patient’s baseline status. 280
  • 281.  Delirium is a mental disturbance characterized by: – New or acutely worsening confusion. – Disorder expression of thoughts. – Change in level of consciousness, or – Hallucinations. 281 Definition-Delirium
  • 282.  Examples of acute mental status changes include: – Apatient who is usually noisy or belligerent becomes quiet, lethargic, or inattentive. – Apatient who is normally quiet and content suddenly becomes restless or noisy. – Apatient who is usually able to find their way around their living environment begins to get lost. 282 ExamplesofAcuteMentalStatusChanges
  • 283. Fluctuation: – The behavior tends to come and go and/or Increase or decrease in severity. – The behavior may fluctuate over the course of the interview or during the assessment period. – Fluctuating behavior may be noted by: • The assessing clinician, • Reported by staff or family, or • Documented in the medical record. 283 Definition-Fluctuation
  • 285. CodingInstructionsforC1310A,AcuteMental StatusChange  Code 0, no, if: – There is no evidence of acute mental status change from the patient’s baseline.  Code 1, yes, if: – Patient has an alteration in mental status observed or reported or identified that represents an acute change from baseline.  Dash is a valid response for this item. 285
  • 287. Inattention: – Reduced ability to maintain attention to external Stimuli and to appropriately shift attention to new external stimuli. – Patient seems unaware or out of touch with environment (e.g., dazed. Fixated or darting attention). 287 Definition-Inattention
  • 288. Coding Instructionsfor C1310B, Inattention  Code 0, behavior not present, if: – The patient remains focused during the assessment,And – All other sources agree that the patient was attentive during other activities. 288
  • 289. CodingInstructionsforC1310B,Inattention  Code 1, behaviorcontinuously present, does not fluctuate, if : – The patient had difficulty focusing attention, – The patient was easily distracted, or – The patient had difficulty keeping track of what was said, and – The inattention did not vary.  All sources must agree that inattention was consistently present to select this code. 289
  • 290. CodingInstructionsforC1310B,Inattention  Code 2, behaviorpresent, fluctuates, if inattention is noted during the assessment or any source reports that: – The patient had difficulty focusing attention, – The patient was easily distracted, or – The patient had difficulty keeping track of what was said, and – The inattention varied, or – If information sources disagree in assessing level of attention. 290
  • 291. CodingInstructionsforC1310B,Inattention  Dash is a valid response for this item. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 291
  • 293. Disorganized Thinking evidenced by: – Rambling, – Irrelevant, or – Incoherent speech. 293 Definition-Disorganized Thinking
  • 294. CodingInstructionsforC1310C, DisorganizedThinking Code 0, behavior not present, if: – All sources agree that the patient’s thinking was organized and coherent, even if answers were inaccurate or wrong. 294
  • 295. CodingInstructionsforC1310C, DisorganizedThinking  Code 1, behavior continuously present, does not fluctuate, if during the assessment and according to other sources: – The patient’s responses were Consistently disorganized or incoherent. – Conversation was rambling or irrelevant, – Ideas were unclear or flowed illogically, or – The patient unpredictably switched from subject to subject. 295
  • 296. CodingInstructionsfor C1310C, DisorganizedThinking  Code 2, behavior present, fluctuates, if during the assessment or according to other data sources, the patient’s responses: – Fluctuated between disorganized/incoherent and organized/clear. – Also, code as fluctuating if information sources disagree. 296
  • 299. CodingInstructionsforC1310D, AlteredLevelofConsciousness  Code 0, behavior not present, if: –All sources agree that the patient was alert and maintained wakefulness during conversation, interview(s), and activities. 299
  • 300. CodingInstructionsforC1310D, AlteredLevelofConsciousness  Code 1, behaviorcontinuously present, does not fluctuate, if during the assessment and according to other sources, the patient was consistently; – Lethargic, – Stuporous, – Vigilant, or – Comatose. 300
  • 301. CodingInstructionsforC1310D, AlteredLevelofConsciousness  Code 2, behaviorpresent, fluctuates, if: – During the assessment or according to other sources, the patient’s level of consciousness varied. – For example, the patient was at times alert and responsive, while at other times the patient was lethargic, stuporous, or vigilant. – Code as fluctuating if information sources disagree. 301
  • 302. C1310A, C1310B,C1310C and C1310D  Dash is a valid response for these items. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 302
  • 303. 303
  • 304. 304
  • 306. 306 OR
  • 307. 307
  • 308. SectionD  New items in this sections are included: – D0150- Patient Mood Interview (PHQ-2 to PHQ-9) – D0160- Total Severity Score. – D0700- Social Isolation. 308
  • 309. 309
  • 312.  Patient Health Questionnaire (PHQ-2 to PHQ- 9): – Avalidated interview that screens for symptoms of depression. – It provides a standardized severity score and a rating for evidence of a depressive disorder. 312 Definition
  • 313.  If the patient appears unable to communicate, offer alternatives such as: – Writing, – Pointing, – Sign language, or – Cue cards. 313 Response-SpecificInstructions
  • 314.  If an interpreter is used during patient interviews, the interpreter should not attempt to determine: – The intent behind what is being translated, – The outcome of the interview, or – The meaning or significance of the patient’s responses. 314 Response-SpecificInstructions
  • 315. 315 CueCard 0-1 (Never or 1 day) 2-6 days (several days) 7-11 days (half or more days) 12-14 days (nearly every day)
  • 317. For each of the questions: – Read the item as it is written. – Do not provide definitions. – Each question must be asked in sequence to assess presence (column 1) and frequency (column 2) before proceeding to the next question. 317 Response-SpecificInstructions
  • 318.  Enter code “9” if : – The patient was unable to complete the interview. – Chose not to complete the interview. – Responded nonsensically, and/or – The agency was unable to complete the assessment.  If Column 1 coded 9, Leave Column 2, Symptom Frequency, blank. 318 CodingInstructionsforColumn1: SymptomPresence
  • 320. 320 Response-SpecificInstructions If the patient rarely/never understood 1. Code D0150A1 & D0150B1 “9.” 2. Leave D0150A2 and D0150B2 blank. 3. End the PHQ-2 Interview. 4. Skip to D0160.
  • 321. 321 Response-SpecificInstructions  If both D0150A2 and D0150B2 are less than 2. 1. There is no need to continue to the PHQ-9. 2. End the PHQ-2, and 3. Enter the total score from D0150A2 and D0150B2 in D0160 (Total Severity Score).
  • 322. 322 Response-SpecificInstructions  If both D0150A2 and D0150B2 are Blank: 1. End the PHQ-2, and 2. Skip D0160.
  • 323. 323 Response-SpecificInstructions  If both D0150A2 and D0150B2 are Coded 9: 1. Leave D0150A2 and D0150B2 Blank, then 2. End the PHQ-2, and 3. Skip D0160.
  • 324. 324 Response-SpecificInstructions  If either D0150A2 or D0150B2 are 2 or 3: 1.Complete the PHQ-9. 2.Proceed to ask the remaining seven questions (D0150C to D0150I) of the PHQ-9, and 3.Complete D0160 (Total Severity Score).
  • 325. 325 Response-SpecificInstructions  If D0150A2 is 0 or 1, and  D0150B2 is 2 or 3: 1.Complete the PHQ-9. 2.Proceed to ask the remaining seven questions (D0150C to D0150I) of the PHQ-9, and 3.Complete D0160 (Total Severity Score).
  • 326. 326 Response-SpecificInstructions  If D0150A2 is 2 or 3, and  D0150B2 is 0 or 1: 1.Complete the PHQ-9. 2.Proceed to ask the remaining seven questions (D0150C to D0150I) of the PHQ-9, and 3.Complete D0160 (Total Severity Score).
  • 330. CodingInstructionsforColumn1: SymptomPresence  Code 0, no: if: – Patient indicates symptoms listed are not present. – Enter 0 in Column 2 as well.  Code 1, yes: if: – Patient indicates symptom listed is present. – Enter 0, or 1, 2, or 3 in Column 2, Symptom Frequency. 330
  • 331.  Enter code “9” if : – The patient was unable to complete the interview. – Chose not to complete the interview. – Responded nonsensically, and/or – The agency was unable to complete the assessment.  If Column 1 was coded 9, Leave Column 2, Symptom Frequency, blank. 331 CodingInstructionsforColumn1: SymptomPresence
  • 332. Dash is a valid response for this item. – Dash indicates “no information.” – CMS expects dash use to be a rare occurrence. 332 CodingInstructionsforColumn1: SymptomPresence
  • 334. Coding Instructionsfor Column2: SymptomFrequency  Code 0, never or 1 day, if: – The patient indicates that during the past 2 weeks: • They have never been bothered by the symptom, or • They have only been bothered by the symptom on 1 day. 334
  • 335. CodingInstructionsforColumn2: SymptomFrequency  Code 1, 2-6 days (several days), if: – The patient indicates that during the past 2 weeks, they have been bothered by the symptom for 2-6 days.  Code 2, 7-11 days (half or more of the days), if: – The patient indicates that during the past 2 weeks, they have been bothered by the symptom for 7-11 days. 335
  • 336. CodingInstructionsfor Column2: SymptomFrequency  Code 3, 12-14 days (nearly every day), if: – The patient indicates that during the past 2 weeks, they have been bothered by the symptom for 12-14 days.  Dash is a valid response for this item. 336
  • 337. 337 CodingTips  If the patient has difficulty selecting between two frequency responses:  Code for the higher frequency.
  • 338. 338 CodingTips  If Column 1 equals 0,  Enter 0 in Column 2  If Column 1 equals 9,  Leave Column 2 blank
  • 339. 339 CodingTips  If the patient describes the presence of a symptom, but cannot quantify a frequency:  Code the presence of the symptom as “1:Yes” in Column 1, and  Enter a dash in Column 2.
  • 340. 340 CodingTips  If a patient gives different frequencies for the different parts of a single item:  Select the highest frequency as the score for that item.
  • 341. CodingTips  Patients may respond to questions: – Verbally, – By pointing to their answers on the cue card, or – By writing out their answers 341
  • 342. InterviewingTips and Techniques If the patient has difficulty selecting a frequency response, start by offering a single frequency response and follow with a sequence of more specific questions. This is known as Unfolding. 342
  • 343. InterviewingTips and Techniques Patients may be reluctant to report symptoms and should be gently encouraged to tell you if the symptom bothered them, even if it was only some of the time. This is known as Probing. 343
  • 344. InterviewingTips and Techniques  To narrow the answer to the response choices available, it can be useful to summarize their longer answer and then ask them which response option best applies.  This is known as Echoing. 344
  • 345. InterviewingTips and Techniques  If the patient has difficulty with longer items, separate the item into shorter parts, and provide a chance to respond after each part.  This method, known as Disentangling. 345
  • 346. 346
  • 347. D0160- Total SeverityScore  The intent of this item is to identify the severity score calculated from responses to the PHQ-2 to PHQ-9. 347
  • 349. ScoringRules The maximum patient score for the Patient Mood Interview Total Severity Score D0160 is 27 (3x9). The Total Severity Score will be: – Between 00 and 27, or – “99” if symptom frequency is blank for three or more items. 349
  • 350. 350 Response-SpecificInstructions  If both D0150A2 and D0150B2 are Coded 9: 1. Leave D0150A2 and D0150B2 Blank, then 2. End the PHQ-2, and 3. Skip D0160.
  • 351. 351 Response-SpecificInstructions  If no assessment is conducted for Symptom Presence: 1. Enter a dash (-) in Column 1, 2. Skip Column 2 in each row of D0150A-I, then 3. Code 99 for D0160.
  • 352. ScoringRules-Column1and 2 If only the PHQ-2 is completed because both D0150A2 and D0150B2 are less than 2 then: 352 Add the numeric scores from these two frequency items and Enter the value in D0160.
  • 353. ScoringRules-Column1and 2 If the PHQ-9 was completed; and If the patient answered the frequency responses of at least 7 of the 9 items on the PHQ- 9: 353  Add the numeric scores from D0150A2-D0150I2, and  Enter that number in D0160 Total Severity Score.
  • 355. ScoringRules-Column1and 2  If symptom frequency in items D0150A2 through D0150I2 is blank for 3 or more items: 355  The interview is NOT complete.  Total Severity Score should be coded as “99.”
  • 357. CodingTips  Responses to PHQ-2 to 9 can be interpreted as follows: – Major Depressive Syndrome is suggested if-- of the 9 items: • 5 or more items are identified at a frequency of half or more of the days (7-11 days) during the look-back period. 357
  • 358. CodingTips – Minor Depressive Syndrome is suggested if of the 9 items, the following items are identified at a frequency of half or more of the days (7-11 days) during the look- back period: 1)D0150B- Feeling down, depressed or hopeless, 2)D0150C- Trouble falling or staying asleep, or sleeping too much, or 3)D0150D- Feeling tired or having little energy. 358
  • 359. CodingTips  Total Severity Score can be interpreted as follows: 359 Score Interpretation 0-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately sever depression 20-27 Severe depression
  • 360. ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  The score in item D0160 is based upon the sum of the values that are contained in the following nine items: –D0150A2, –D0150B2, –D0150C2, –D0150D2, –D0150E2, –D0150F2, –D0150G2, –D0150H2, –D0150I2. 360
  • 361. RulesHowtoComputetheScoreforitem D0160  These rules consider the "number of missing items in Column 2" which is the number of items in Column 2 that are either skipped or are equal to dash. – An item in Column 2 is skipped if the corresponding item in Column 1 was equal to 9. – An item in Column 2 could be equal to dash if the item could not be assessed for some other reason. 361
  • 362. ScoringRules: PatientMoodInterview TotalSeverityScoreD0160  If all of the items in Column 2 have a value of 0, 1, 2, or 3 then: 362  Item D0160 is equal to the simple sum of those values.
  • 363. ScoringRules: PatientMoodInterview TotalSeverityScoreD0160  If any of the items in Column 2 are skipped or equal to dash, then 363  Omit their values when computing the sum.
  • 364. ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  If the number of missing items in Column 2 is equal to one, then: 364 1.Compute the simple sum of the eight items in Column 2 that have non-missing values, 2.Multiply the sum by 9/8 (1.125), and 3.Place the result rounded to the nearest integer in item D0160.
  • 365. ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  If the number of missing items in Column 2 is equal to two, then: 365 1. Compute the simple sum of the seven items in Column 2 that have non-missing values, 2. Multiply the sum by 9/7 (1.286), and 3. Place the result rounded to the nearest integer in item D0160.
  • 366. ScoringRules:PatientMoodInterviewTotal SeverityScoreD0160  If the number of missing items in Column 2 is equal to three or more, then 366  Item D0160 must equal to “99.”
  • 367. 367
  • 368. D0700- SocialIsolation-New  The intent of this item is to identify the patient’s actual or perceived lack of contact with other people, such as living alone or residing in a remote area. 368
  • 369. Definitionof SocialIsolation  Social isolation refers to an actual or perceived lack of contact with other people, such as: – Living alone, or – Residing in a remote area. 369
  • 370. Response –specific Instructions  This item is intended to be a patient self-report item.  No other source should be used to identify the response.  Ask the patient “How often do you feel lonely or isolated from those around you?”  Complete as close to the time of SOC/ROC and DC as possible. 370
  • 371. Coding Instructions  Code 0, Never, if the patient indicates never feeling lonely or isolated from others.  Code 1, Rarely, if the patient indicates rarely feeling lonely or isolated from others.  Code 2, Sometimes, if the patient indicates sometimes feeling lonely or isolated from others.  Code 3, Often, if the patient indicates often feeling lonely or isolated from others. 371
  • 372. Coding Instructions  Code 4,Always, if the patient indicates always feeling lonely or isolated from others.  Code 7, Patient declines to respond, if the patient declines to respond.  Code 8, Patient unable to respond, if the patient is unable to respond.  Dash is not a valid response for this item. 372
  • 373. 373
  • 374. 374
  • 376.  Code 3, Independent, If the patient completed ALLthe activities by themselves with or without an assistive device, with no assistance from a helper.  Code 2, Needed Some Help, if the patient needed partial assistance from another person to complete Any of the activities.  Code 1, Dependent, if the helper complete ALL the activities for the patient, or the assistance of two or more helpers was required for the patient to complete then activities. 376 GG0100:PriorFunctioningItemRevisions(cont.)
  • 377.  Code 8, Unknown, if the patient’s usual ability prior to the current illness, exacerbation, or injury is unknown.  Code 9, NotApplicable, if the activities were not applicable to the patient prior to the current illness, exacerbation, or injury. 377 GG0100:PriorFunctioningItemRevisions(cont.)
  • 378.  For GG0100-Prior Functioning: EverydayActivities: – Report the patient’s functional ability prior to the onset of the current illness, exacerbation of a chronic condition, or injury, whichever is most recent, that initiated this episode of care. – Completing the stair activity for GG0100C. Stairs indicates that a patient went up and down the stairs, by any safe means, with or without handrails or assistive devices or equipment, and/or with or without some level of assistance. 378 GG0100:PriorFunctioningCodingTips
  • 379. 379
  • 381.  For GG110. Prior Device Use: – Report the devices used by the patient prior to the onset of the current illness, exacerbation of a chronic condition, or injury, whichever is more recent, that initiated this episode of care. – For the response category in this item, CMS does not provide an exhaustive list of assistive devices that may used when coding prior device use. – Devices may have been used indoors and/or outdoors. 381 GG0110: PriorDeviceUse(cont.)
  • 382.  GG0110C, Prior Devices: Mechanical lift Includes any mechanical device or equipment a patient or caregiver requires for lifting or supporting the patient’s bodyweight. 382 GG0110:PriorDeviceUseUpdate/revision
  • 383.  Examples include, but are not limited to: – Stair lift, – Hoyer – Bathtub lift, – Sit-to-stand lift, – Stand assist, – Electric recliner, and – Full-body style lifts, if required.  Clinical judgment may be used to determine whether other devices meet the mechanical lift definition provided. 383 GG0110:PriorDeviceUseUpdate/revision(cont.)
  • 384.  GG0110D, Walker refers to all types of walkers. Examples include, but are not limited to, – Pick-up walkers, – Hemi-walkers, – Rolling walkers, and – Platform walkers. 384 GG0110:PriorDeviceUseUpdate/revision(cont.)
  • 385.  Code Z, None of the above, if the patient did not use any of the listed devices or aids immediately prior to the current illness, exacerbation, or injury.  Dash is a valid response for this item. –Dash indicates “no information.” –CMS expects dash use to be a rare occurrence. 385 GG0110:PriorDeviceUseUpdate/revision (cont.)
  • 386. 386
  • 387.  Licensed clinician may assess the patient’s self-care and mobility performance based on:  Direct observation (preferred),  Patient/caregiver report,  Assessment of similar activities, and/or  Collaboration with other agency staff who have had direct contact with the patient, or  Some other means of gathering information. 387 RevisedGeneralResponseSpecificInstructions forGG0130/GG0170
  • 388.  Guidanceonhowtocodeanactivitywhenonlyaportionof theactivityhasbeencompleted:  If the patient only completes a portion of the activity and does not complete the entire activity during the assessment time frame, use clinical judgment to determine if the situation allows the clinician to adequately assess the patient’s ability to complete the activity. 388 (New) General ResponseSpecific Instructionsfor GG0130/GG0170
  • 389.  If the clinician determines that this observation is adequate, code based on the type and amount of assistance the patient requires to complete the Entire activity.  If the clinician determines the partial activity does not provide adequate information to support determination of a performance code, select an appropriate“Activity not attempted” code. 389 (New)GeneralResponseSpecific InstructionsforGG0130/GG0170(cont.)
  • 390.  When a function activity is not completed entirely during one clinical observation, code based on the type and amount of assistance required to complete the entire activity. 390 (New)GeneralResponseSpecific InstructionsforGG0130/GG0170(cont.)
  • 391. The time period under consideration is the look-back period to use when coding each OASIS item.  For most items, the look-back is the Day of Assessment.  For other items, the look-back period is different, such as “in the last 14 days” or “at the time of or since the most recent SOC/ROC.” 391 TimingDefinitionforGG0130/GG0170