Home Health & Hospice Week

Confusing wording could trip up your OASIS coding for vaccination process measures, if you don't learn an important distinction. When you answer "yes" to M1040, you'd better make sure four conditions apply.

Scenario: You are discharging a patient on Jan. 2, 2010, at the end of his second separate episode of care that had a start of care date of Dec.

1, 2009. You had already administered the seasonal flu vaccine to the patient on Sept. 25, 2009, during his first separate episode of home care.

Question #1: How do you answer M1040 (Influenza Vaccine: Did the patient receive the influenza vaccine from your agency for this year's influenza season [October 1 through March 31] during this episode of care?) in your discharge assessment?

Your answer options for M1040 are:

0 -- No

1 -- Yes

NA - Does not apply because the entire episode of care (SOC/ROC to Transfer/Discharge) is outside this influenza season.

After reviewing your options, you can report:

A) 1 -- because the patient received this year's flu vaccine from your agency.

B) 0 --- because the patient did not receive the flu vaccine during this episode of care.

C) 0 -- because the patient received the flu vaccine prior to Oct. 1.

Question #2: If your answer to question #1 is no, how do you answer M1045 (Reason influenza vaccine not received: If the patient did not receive the influenza vaccine from your agency during this episode of care, state reason).

Your answer options are:

1 - Received from another agency provider (e.g., physician)

2 - Received from your agency previously during this year's flu season

3 - Offered and declined

4 - Assessed and determined to have medical contraindication

5 - Not indicated; patient does not meet age/condition guidelines for influenza vaccine

6 - Inability to obtain vaccine due todeclared shortage

7 - None of the above

After reviewing your options, you can report:

A) 1 - Received from another health care provider. You choose this because a different clinician administered the vaccine in the previous episode.

B) 2 - Received from your agency previously during this year's flu season. You choose this because the flu vaccine was given by your agency during the previous episode.

C) 7 - None of the above. You choose this instead of "2" because the patient received the vaccine on Sept. 25 and M1040 says that the influenza season is Oct. 1 through March 31.

Correct answer to #1: B. For you to be able to answer "yes" to M1040, four conditions must apply. First, some part of the episode must be within the influenza season (defined for this question as October 1 through March 31). Second, the patient must receive the vaccine from your agency. Third, the vaccine you provided must have been for the current year's influenza season. Finally, you must have provided the vaccine during the current episode -- the one for which you are doing a discharge/transfer assessment.

But don't get thrown by the definition of the influenza season as Oct. 1 through March 31, the Centers for Medicare & Medicaid Services tells agencies. In question and answer "6" of the October 2009 CMS OASIS Q&As, CMS says it specified that time period so agencies could use it to identify "if the current outcome episode (SOC/ROC to Transfer/Discharge) is outside of the flu season, for purposes of selecting response NA."

Correct answer to #2: B. In question and answer "7" of the October 2009 CMS OASIS Q&As, CMS clarifies that as long as part of the current episode occurred within the Oct. 1 through March 31 timeframe, it doesn't matter if the agency administered the vaccine outside of those dates.

"Each year, flu vaccine manufacturers only release the vaccine per CDC recommendations. If the flu vaccine has been made available and distributed for administration, it is considered to be within that year's flu season," CMS says.

Note: For more details about OASIS C, see Eli's OASIS Alert online at www.elihealthcare.com/spec_oasis.htm