Home Health & Hospice Week

Some clarifications may surprise you.

Think your clinicians know how to answer OASIS questions on pain accurately? You may have to think again after reading new OASIS guidance.

The Centers for Medicare & Medicaid Services this month added 57 questions and edited five in the set of OASIS Q&As available through its Web site.

One major area for clarification is in the OASIS questions on pain assessment. M0420 (Frequency of pain interfering with activity or movement) is not a measurement of pain, but of how much pain interferes with activity, explains Linda Krulish, president of Redmond, WA-based OASIS Answers Inc.

"Clinicians seem to have a particularly hard time with this question," says senior clinical consultant Judy Adams with the Charlotte, NC-based LarsonAllen Health Care Group. Even when clinicians do recognize the focus of the question, they are unclear about how to define pain interfering with activity, she tells Eli.

Clinicians also struggle with M0430 (Intractable Pain: Is the patient experiencing pain that is not easily relieved, occurs at least daily, and affects the patient's sleep, appetite, physical or emotional energy, concentration, personal relationships, emotions, or ability or desire to perform physical activity), Adams notes.

M0420 is one of the questions that adds points to the home health resource group case mix classification, with a "2" or "3" adding five points to the clinical severity domain.

As with any question likely to increase the reimbursement paid to an agency for a home health episode, fiscal intermediaries may scrutinize this question closely, and agencies should focus extra attention on accuracy.

Training opportunity: The number of new questions makes it even more important for OASIS training to be an ongoing process, Adams says.

When clinicians have been taking an "all or nothing" approach and interpreting M0420 to mean the pain must totally interfere with the activity, use questions 70 to 72 in section four of the Q&As to illustrate how pain can interfere with an activity without preventing it, Adams suggests.

For clinicians confused about how to answer M0420 when pain medication works, but side effects interfere with activity, refer them to question 73, she says. And questions 75 and 76 will clarify the requirements for saying the patient has intractable pain in M0430, she adds.

Tip: Be sure the clinician documents very carefully if the answer to M0420 is that pain doesn't interfere with activity but M0430 says the patient has intractable pain, Adams warns.

And to avoid downcoding, once staff note pain on admission in M0420, they must address it in visit notes, calls to the physician, medication changes or other medical record documentation, advises regional home health intermediary Cahaba GBA in a Web site home health update.

Note: The new OASIS Q&As are at www.qtso.com/hhadownload.html.

See Eli's OASIS Alert at www.elihealthcare.com/spec_oasis.htm for more information on the new Q&As.