Home Health & Hospice Week

Don’t forget to listen to CMS’s OASIS-C1 call Sept. 3.

The diagnosis code M items may be on hold until ICD-10’s implementation date in October 2015, but you still have plenty to prepare for when the rest of the OASIS tool gets an update in the new year. Make sure you know your way around the new OASIS-C1/ICD-9 — including the risk of hospitalization item — before its Jan. 1 implementation date.

The Centers for Medicare & Medicaid Services is making numerous non-diagnosis-coding-related revisions to the OASIS form, noted Judy Adams with Adams Home Care Consulting in Asheville, N.C. These changes include updating clinical concepts and modifying item wording and response categories to improve item clarity, Adams said in the Eli-sponsored audioconference, "OASIS-C1 Changes."

Watch for: Wording changes in 44 OASIS items aim to make the language clearer in OASIS-C1/ICD-9. Expect more straightforward directions and response options and more specific data collection periods. You can also say goodbye to confusing abbreviations, as "for example" replaces "e.g." and "specifically" takes the place of "i.e." throughout the OASIS.

CMS also revised many response items to be consistent with information contained in the OASIS-C Guidance Manual.

Bid Farewell to Inpatient Procedures, Pressure Ulcer Items

The OASIS-C1 removes five items at all time points. The data currently gathered by these items isn’t used for payment, quality, or risk adjustment, Adams said. They include:

• M1012 — Inpatient Procedures. Since Ap-ril 2011, CMS hasn’t required home health agencies to list a procedure code for this once time-consuming item. But, under OASIS-C you must respond "NA" or "Unknown." With OASIS-C1, the item is completely removed.

• M1310, M1312, and M1314 which report the length, width, and depth of the pressure ulcer with the largest surface dimension. The intent of these items was to show whether a pressure ulcer improved, but they didn’t always track the same ulcer from one OASIS to the next, so the items weren’t as useful as hoped, Adams said. These items aren’t included on OASIS-C1.

• M2440 — For what Reason(s) was the patient Admitted to a Nursing Home? is also slated for removal from the OASIS-C1 data set.

While many familiar items will undergo minor changes in OASIS-C1, the risk for hospitalization item will see a more extensive makeover.

Currently, M1032 — Risk for Hospitaliza-tion asks "Which of the following signs or symptoms characterize this patient as at risk for hospitalization?" Your options include:

1 — Recent decline in mental, emotional, or behavioral status

2 — Multiple hospitalizations (2 or more) in the past 12 months

3 — History of falls (2 or more falls — or any fall with an injury — in the past year)
4 — Taking five or more medications
5 — Frailty indicators, e.g., weight loss, self-reported exhaustion

6 — Other

7 — None of the above.

In OASIS-C1, M1032 will change to M1033 and your response options expand to the following (new or changed items in italics):

1 — History of falls (2 or more falls — or any fall with an injury — in the past 12 months)

2 — Unintentional weight loss of a total of 10 pounds or more in the past 12 months

3 — Multiple hospitalizations (2 or more) in the past 6 months

4 — Multiple emergency department visits (2 or more) in the past 6 months

5 — Decline in mental, emotional, or behavioral status in the past 3 months

6 — Reported or observed history of difficulty complying with any medical instructions (for example, medications, diet, exercise) in the past 3 months

7 — Currently taking 5 or more medications

8 — Currently reports exhaustion

9 — Other risk(s) not listed in 1-8

10 — None of the above.

Item M1033 will provide greater definition of the appropriate look-back period for these hospitalization risk factors, Adams said. The item will include additional risk factors for hospitalization predictors that aren’t currently on the OASIS.

Unchanged: You can still check all of the M1033 responses that apply for your patient.

Don’t Forget To Listen

You can find out more about the OASIS-C1 tool in CMS’s Sept. 3 webinar on the topic. The agency says it will go over the new OASIS-C1/ICD-9 data set and its implementation; types of changes made to the data set; OASIS-C1/ICD-9 Guidance Manual changes, and an OASIS questions-and-answers update.

The webinar is limited to 1,000 lines, so call in early to secure your spot. CMS recommends calling in a half hour before the 90-minute webinar starts at 2 p.m. ET.

CMS will post an archived copy of the web-inar about a month after it takes place.

Resource: Information on dialing in, submitting questions, and more is in the notice at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-40.pdf.

Note: To get more information on OASIS-C1 changes, sign up for an Aug. 28 Eli-sponsored audioconference, "OASIS — Tips and Training," at www.audioeducator.com/home-health/oasis-tips-training-08-28-14.html.