Home Health & Hospice Week

A new clarification on the heart failure process measure coded in OASIS-C could make you look bad if you don't document carefully.

M1500 (Symptoms in Heart Failure Patients) used to say that if heart failure was not coded in M1010, M1016, or M1020/M1022/M1024 on the last assessment, the clinician had to answer M1500      "NA," points out OASIS expert Trish Twombly with Foundation Management Services in Denton, Texas. Changes in the updated guidance give you the ability to answer "yes" even if heart failure wasn't coded among the top six diagnoses last assessment, she says.

Response-specific instructions for this item now read "Select Response options 0, 1, or 2 if the patient has a diagnosis of heart failure, regardless of whether the diagnosis is documented elsewhere in the OASIS assessment," according to the OASIS C Guidance Manual updated in December.

The January 2011 quarterly questions and answers that the Centers for Medicare & Medicaid Services sends to the OASIS Certificate and Competency Board also offer new guidance for completing M1500.

Question: Our nurse was notified by family that her patient, who has a diagnosis of heart failure, was admitted to the hospital due to increased shortness of breath (SOB) due to congestive heart failure (CHF). The patient had not exhibited signs or symptoms of heart failure since the start of care (SOC). Because the family chose not to call the agency, no visit was made to assess the patient for signs and symptoms of CHF on the day he went into the hospital. How do we answer M1500 (Symptoms in Heart Failure Patients) and M1510 (Heart failure follow-up) in this situation?

Answer: When M1500 is answered at transfer or discharge, "1 -- Yes" is the appropriate response if the patient had a diagnosis of heart failure and exhibited symptoms of heart failure at or since the previous OASIS assessment. In your scenario, the patient had a diagnosis of heart failure and the record review revealed that the patient experienced SOB. The SOB resulted in a qualifying hospitalization since the previous OASIS assessment.

When completing the transfer OASIS, the clinician would answer M1500 "1 -- Yes", even though the agency did not have the opportunity to assess the symptoms during a visit. When answering M1510, you report the actions your agency took in response to the heart failure symptoms. If no actions were taken, response "0 -- No action taken" would be appropriate. Include an explanation of your "No" response in the clinical record.