Home Health & Hospice Week

Clear up early days confusion between dashes and Code 8.

Medicare makes clear in the OASIS-D Guidance Manual, OASIS-D training, and elsewhere that home health clinicians should use dashes as little as possible when completing the newly revised assessment instrument.

The Centers for Medicare & Medicaid Services “expects the use of a dash to be a rare occurrence,” the agency reiterates in a 105-question set posted recently in response to questions from its OASIS-D training sessions.

Excessive use of dashes may be a red flag for surveyors or other auditors, experts caution.

The Q&As show where you may be able to avoid using dashes when you don’t have to.

Question: “For GG0100. Prior Functioning: Everyday Activities, what is the difference between a dash and Code 8, Unknown?” a home health agency asked CMS.

Answer: For GG0100, Code 8, Unknown indicates “when no information about the patient’s usual ability prior to the current illness, exacerbation, or injury is available after attempting to interview the patient or family and after reviewing the patient’s clinical record,” CMS explains. “A dash indicates that no information is available and no attempt was made to gather the information.”

CMS elaborates on the issue in a separate Q&A, giving examples of each answer.

For a dash: “A dash would be an appropriate response if there is no information regarding the patient’s prior ability with everyday activities because the agency did not attempt to collect this information”

CMS says. “For example, at SOC, the patient was recently admitted to an assisted living facility after having a stroke with severe memory loss. The clinician did not attempt to communicate with the patient and did not attempt to access available medical records or caregivers to determine prior functioning.”

For Code 8: “If the agency attempted to gather the information by interviewing the patient and family and/or reviewing the patient’s clinical record and no information was available, use Code 8, Unknown,” CMS continues.

Note: The Q&A set is at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/November-2018-HH-QRP-Provider-Training-Q-and-A.pdf.