Home Health & Hospice Week

Say goodbye to your old M1308 headaches in the revised assessment tool.

The OASIS integumentary items are some of the trickiest to answer correctly. But when the OASIS-C1 debuts on its new implementation date of Jan. 1, expect some of the bumps in the road to OASIS accuracy to be smoothed out with changes to these wound items.

“The wound questions are always the most problematic in the OASIS,” said OASIS expert Judy Adams with Adams Home Care Consulting in Asheville, N.C. “The changes [in OASIS-C1] should help.”

Welcome These Wording Changes

Several items in OASIS-C1 have minor wording changes that will help make the items easier to interpret. In the integumentary section, the re-worded items include:

• M1306: Does the patient have at least one unhealed pressure ulcer at Stage II or higher or designated as “unstageable”? Immediately following the item title, the Centers for Medicare & Medi-caid Services has added the instructions “Excludes Stage I pressure ulcers and healed Stage II pressure ulcers.” This guidance was pulled from the OASIS-C Guidance Manual and into the question itself, Adams said during an Eli-sponsored audioconference, “OASIS-C1 Changes.”

• M1307: The Oldest Stage II Pressure Ulcer that is present at discharge: You’ll notice that this item title has been reworded from OASIS-C’s “Oldest Non-epithelialized Stage II Pressure Ulcer that is present at discharge.” OASIS-C1 also adds the following instruction immediately following the item title: “(Excludes healed Stage II Pressure Ulcers).” You’re reporting “an ulcer that’s there instead of one that is healed,” Adams said. The “NA” option for this item will read “No Stage II pressure ulcers are present at discharge.” This further drives home the point that a healed Stage II pressure ulcer is gone and should not be reported as a current wound.

• M1320: Status of Most Problematic Pressure Ulcer that is Observable. Reworded from OASIS-C’s “Status of Most Problematic (Observa-ble) Pressure Ulcer,” this item makes better sense and should be easier to answer as a result, Adams said. Immediately following the item title, the additional instruction pulled from the OASIS-C Gui-dance Manual that this item “Excludes pressure ulcer that cannot be observed due to a non-removeable dressing/device” gives additional clarity.

• M1324: Stage of Most Problematic Un-healed Pressure Ulcer that is Stageable. OASIS-C1 removes the word “observable” from this item title and adds the instruction “Excludes pressure ulcer that cannot be staged due to a non-removable dressing/device, coverage of wound bed by slough and/or eschar, or suspected deep tissue injury.” The “NA” response also changes to read: “Patient has no pressure ulcers or no stageable pressure ulcers” rather than OASIS-C’s “No observable pressure ulcer or unhealed pressure ulcer.”

Look For A Whole New M1308

Perhaps the most anticipated change to the assessment tool is the OASIS-C1’s revamp of M1308: Current Number of Unhealed (non epithelialized) Pressure Ulcers at Each Stage. The first thing you’ll notice about the new M1308 is the item title that reads “Current Number of Unhealed Pressure Ulcers at Each Stage or Unstageable.” You’ll complete M1308 at the start of care (SOC), resumption of care (ROC), follow-up, and discharge time points.

The biggest change in M1308 is reducing this item from two columns to one.

Confusing: In OASIS-C, you complete M1308’s Column 2 at follow-up and discharge to show the number of current pressure ulcers listed in Column 1 that were present at the most recent SOC and ROC. Completing this second column accurately is tricky, so it’s welcome news that it’s been deleted in OASIS C-1.

Add A New Pressure Ulcer Item

As you say goodbye to M1308 Column 2, get ready to greet M1309: Worsening in Pressure Ulcer Status since SOC/ROC. Here, you’ll indicate the number of current pressure ulcers that were not present or were a lesser stage at the most recent SOC/ROC, Adams said. You’ll complete this item at discharge only. This new item replaces the second column of M1308.

In this new item you can record pressure ul-cers that are unstageable due to coverage of the wound bed by slough or eschar. You’ll also be able to report new pressure ulcers or those that were previously Stage I or Stage II at the most recent SOC or ROC.

M1309 “shows if pressure ulcers are worsening,” Adams said. “This will be a clearer picture of worsening pressure ulcers.”

“The elimination of the second column of M1308 and the addition of M1309 updates were developed to have greater harmonization of wording with other post-acute data collection instruments,” Adam said.

The new M1309 isn’t perfect, though, points out consultant and attorney Lisa Selman-Holman of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. CMS needs to clarify whether you mark in M1309 the level that the pressure ulcer was originally, or the new worse level. Hopefully the OASIS-C1 Guidance Manual will clarify that, she tells Eli. 