Home Health & Hospice Week

Crucial: Know how to assess an intercepted fall.

If you don’t learn the ins and outs of one of the new J section items in OASIS-D, you risk reporting incorrect data come Jan. 1.

In the revamped OASIS tool that takes effect in the new year, the Centers for Medicare & Medicaid Services will be adding Section J on Health Conditions. For the present, section J consists of two items:

J1800: Any Falls Since SOC/ROC, whichever is more recent. J1800 asks the question “Has the patient had any falls since SOC/ROC, whichever is more recent?” If the clinician answers “no” (response 0), she can skip J1900. If she answers “yes” (response 1), she proceeds to J1900.

J1900: Number of Falls Since SOC/ROC, whichever is more recent. Clinicians can choose A. No injury (No evidence of any injury is noted on physical assessment by the nurse or primary care clinician; no complaints of pain or injury by the patient; no change in the patient’s behavior is noted after the fall); B. Injury (except major) (Skin tears, abrasions, lacerations, superficial bruises, hematomas and sprains; or any fall-related injury that causes the patient to complain of pain); or C. Major injury (Bone fractures, joint dislocations, closed head injuries with altered consciousness, subdural hematoma).

The guidance for this new item is something “clinicians and agencies should pay specific attention to,” urges OASIS expert Sherri Parson with Quality in Real Time in Floral Park, New York — particularly CMS’s guidance on “intercepted falls.”

According to the response-specific instructions for J1800 in the newly released OASIS-D Guidance Manual, “an intercepted fall occurs when the patient would have fallen if he or she had not caught him/herself or had not been intercepted by another person — this is still considered a fall.”

Assessing clinicians should take note that the new J1800 guidance instructs “that an intercepted fall … should still be documented and noted as a fall for this question,” advises Diane Magrady, compliance lead with Morton Grove, Illinois-based Pragma-IT, creator of the therapyBOSS therapy documentation software solution.

Check out this example CMS offers in the manual: “An incident report describes an event in which Mr. S appeared to slip on a wet spot on the floor during a home health aide bath visit. He lost his balance and bumped into the wall, but was able to steady himself and remain standing.”

Exception: “CMS understands that challenging a patient’s balance and training him/her to recover from a loss of balance is an intentional therapeutic intervention and does not consider anticipated losses of balance that occur during supervised therapeutic interventions as intercepted falls,” the manual adds.

However, not every fall during therapy qualifies for the exception, CMS notes. The manual offers this example: “A patient is ambulating with a walker with the help of the physical therapist. The patient stumbles and the therapist has to bear some of the patient’s weight in order to prevent a fall.” The assessing clinician should code J1800 as 1 (Yes) because “the patient’s stumble was not anticipated by the therapist. The therapist intervened to prevent a fall. An intercepted fall is considered a fall,” the manual instructs.

This example shows “there is a distinction between a fall that is expected with therapy services and one not expected even with therapy present at the time,” Parson points out.

Contrast the previous scenario with this example the manual offers: “A patient is participating in balance retraining activities during a therapy visit. The therapist is intentionally challenging patient’s balance, anticipating a loss of balance. The patient has a loss of balance to the left due to hemiplegia and the physical therapist provides minimal assistance to allow the patient to maintain standing.”

In this scenario, the assessing clinician codes J1800 as 0 (No) because “the patient’s balance was intentionally being challenged by the physical therapist, so a loss of balance is anticipated,” the manual explains. “When assistance is provided to a patient to allow him/her to maintain standing during an anticipated loss of balance during a supervised therapeutic intervention, this is not considered a fall or intercepted fall.”

Don’t be surprised if staff get confused when coding J1800, Parson says. “Make sure staff understand the subtle differences between intercepted falls and those therapy-related challenges,” she counsels.

Do this: “I strongly encourage clinicians to take the time to complete the examples for this item,” Parson counsels. Reviewing the scenarios offered in the manual is “very helpful with making that distinction,” Parson tells Eli.

Note: The OASIS-D Guidance Manual is at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/draft-OASIS-D-Guidance-Manual-7-2-2018.pdf.