Home Health & Hospice Week

Don't let these common mistakes cost you $1,500 per patient. The message is clear: OASIS coding of wound care is in the spotlight.

Intermediaries' medical reviewers are combing through home health agencies' OASIS items on wound care and downcoding claims when they don't find correct documentation. And surveyors are clued into correct OASIS coding procedures after being required to watch the Centers for Medicare & Medicaid Services' two-and-a-half hour training session April 23.

It won't be long until the HHS Office of Inspector General and other fraud and abuse hounds are on the trail of the OASIS items that can make a $1,500 difference in per-episode payments, experts predict.

At the session, CMS and its OASIS contractor, the Center for Health Services and Policy Research at the University of Colorado Health Sciences Center, offered these tips for accurately filling out the OASIS items on wound care:

Pressure Ulcers

M0440 (Does this patient have a Skin Lesion or an Open Wound? This excludes "OSTOMIES.") Adds 21 to clinical severity domain if the patient has a burn or trauma diagnosis.

Experts have advised that almost every patient has some sort of skin lesion, which is defined as "all alterations in skin integrity" in the OASIS Manual Chapter 8. But HHAs have been reluctant to mark lesions if they are not addressed in the care plan.

Not to worry, said CHSPR's Kathy Crisler. Agencies can mark lesions, such as old scars, that aren't receiving current interventions or treatments.

Bottom line: Agencies also shouldn't hesitate to mark "yes" to M0440 if they don't later mark any pressure ulcers, stasis ulcers or surgical wounds. Other wounds, such as diabetic and arterial ulcers, aren't specifically captured in the OASIS tool, Crisler noted. M0445 (Does this patient have a Pressure Ulcer?). No points.

The OASIS items on pressure ulcers have long bewildered HHA clinicians, because you must mark a pressure ulcer even when it is fully healed. "This is the only lesion that continues to be marked as present once it heals," Crisler confirmed. M0450 (Current Number of Pressure Ulcers at Each Stage). Adds 17 to clinical severity score if two or more ulcers are stage 3 or 4.

Even more confusing for clinicians is that reverse staging is prohibited for pressure ulcers. That means you must score the ulcer at its worst condition, even once it is completely healed.

That approach reflects the fact that the skin where the ulcer was is never as strong as it was before the ulcer, wound care expert Dorothy Doughty from Emory University in Atlanta said in the session.

If your patient comes on service with a healed pressure ulcer, you must consult the patient's physician or referral source to determine the worst stage the ulcer has been, Crisler said.

Don't be fooled: [...]