Home Health & Hospice Week

Make sure you're following the latest OASIS Manual instructions.

If you fail to heed the latest revision to OASIS instructions, your outcomes and finances will suffer.

More than two months after releasing a flawed OASIS revision, the Centers for Medicare & Medicaid Services posted a new copy Oct. 24.

"Chapter 8 has been corrected since the June 2006 release [actually posted in mid-August]. We apologize for any inconvenience," CMS says on its Web site. The information in the revised manual is effective immediately, CMS says.

"All home health agencies need to keep up to date on the official information and guidance on OASIS items," urges consultant Judy Adams with Larson-Allen based in Charlotte, NC.

Note These Changes

One of the more obvious errors was the severity ratings inserted in M0245 (Payment diagnoses). The new release removes them.

It also revises the case mix code definition. "I am sure this refers to the fact that all pertinent diagnoses have to be listed on the Plan of Care," offers Adams.
 
Tip: If you have an incorrect and a corrected copy of the revisions, one way to be sure you are looking at the corrected copy is to go to M0245. If you see severity ratings, you are using an incorrect copy.

Another error was that CMS removed from M0190 the HIPAA-compliant language about coding specificity (Inpatient diagnoses and ICD-9-CM code categories). CMS corrected this problem in M0190 and in M0210 too, notes consultant Lisa Selman-Holman with Selman-Holman & Associates in Denton, TX.

And in M0450 (Current number of pressure ulcers at each stage), CMS removed language discussing healed Stage 2 pressure ulcers with and without scar formation.

The statement "was just plain wrong," says OASIS expert Linda Krulish of Redmond, WA-based OASIS Answers. A healed Stage 2 pressure ulcer is no longer a pressure ulcer, whether or not it heals with scar tissue, she explains.

"If a person who previously had a stage 1 or 2 pressure ulcer develops a new pressure ulcer, it will be staged at whatever stage it is," Adams adds.

CMS Adds Better Explanations

Other CMS corrections clarify confusing language or provide additional explanation. These include:

• M0460 (Stage of most problematic [observable] pressure ulcer). Refers clinicians to the Wound Ostomy and Continence Nurses' Web site for access to specific guidance on staging pressure ulcers.

• M0484 (Current number of [observable] surgical wounds). More clearly explains when a single surgical wound can become multiple surgical wounds.

• M0670 (Bathing). Clarifies that this item does not assess the patient's ability to transfer into and out of the tub or shower.

• M0830 (Emergent care). Elaborates on how to treat a "hold" after which the patient may or may not be admitted to the hospital at the end of the hold period. "The new wording is a bit clearer," Adams observes.

Do this: "Reviewing the manual for changes provides a good opportunity for the overall review of the OASIS items and instructions," Adams offers. And providers "need to update their books since there are always new staff coming to the agency," she adds.