Home Health Coding and OASIS Expert

You don’t have to provide all the education to take credit for M2015.

Is your patient at risk of being rehospitalized as the result of a medication problem? Making certain your patients and their caregivers are properly educated about their medications is one of the most important things you can do to promote a successful transition to home care. Give your OASIS medication items approach a tune-up to make certain your patients remain in the home and your outcomes accurately reflect all the work your agency is doing.

Understand High Risk

OASIS item M2010 — Patient/Caregiver High Risk Drug Education asks whether the patient or caregiver has received instruction on special precautions for all high-risk medications as well as how and when to report any problems that may occur. You’ll complete this item at start of care (SOC) and resumption of care (ROC).

Responses options for this item include:

• 0 — No
• 1 — Yes
• NA — Patient not taking any high risk drugs OR patient/caregiver fully knowledgeable about special precautions associated with all high-risk medications

High risk medications have been identified by quality organizations such as the Institute for Safe Medication Practices or the Joint Commission as “having considerable potential for causing significant patient harm when they are used erroneously,” according to the OASIS-C1/ICD-10 Guidance Manual.

Tip: While M2010 specifies that you could consider drugs such as hypoglycemic and anticoagulants high risk, it’s up to each agency to determine which drugs meet the definition, based upon reliable authoritative resources, according to the Centers for Medicare & Medicaid Services’ OASIS-C online training for the medication items. Check your agency’s policies to make certain you know which medications you should be considering when answering this item.

Your patients’ medication education should address any precautions they can take to reduce risk of harm from their high risk medications.

For example: Suppose your patient is on a hypoglycemic. You should instruct the patient or the caregiver to carry something such as candy, glucose tablets, or cake icing with them to reverse hypoglycemia if it should occur as a result of the high-risk medication, according to the CMS medication item training.

What: Patients and caregivers should also know what symptoms or problems they should report to the nurse or physician. This makes it possible to establish interventions to help mitigate potentially harmful complications, CMS says.

When: Medication education must also outline when a patient should call with a problem, such as “immediately” or “if these signs or symptoms occur,” CMS says.

How: Patients and caregivers should know who to contact — the nurse or physician — for which problems. And they should have the appropriate phone numbers accessible.

For example: If the patient is taking an anticoagulant, you should instruct the patient or caregiver to report any blood in their urine (what) to their physician or nurse (how) immediately (when).

Select the Correct Response

Consider the following criteria outlined in the CMS online training when deciding how to answer M2010.

Choose response “NA” when:

• The patient is not currently taking any high risk drugs; or
• When the patient and/or caregiver is fully knowledgeable about all special precautions for all the high risk medications he is taking.

Tip: Be sure to document the patient and caregiver’s knowledge level in the clinical notes, CMS says in the training.

Choose response “0 — No” when:

The education provided did not include all of the following:

• All the high risk drugs.
• Precautions necessary to prevent harm to the patient.
• What, when and how to report by the allowed assessment timeframe.

Choose response “1 — Yes” when:

• High Risk Drug(s) are prescribed; and
• Education covered all of the following: All the high risk drugs, precautions necessary to prevent harm to the patient, and what, when and how to report; and
• Education occurred by the end of the allowed time frame.

Tip: High risk drug education can be completed by another clinician. But the clinician must communicate this information to the clinician completing the OASIS. If your agency allows this arrangement, be sure to take this into account when completing M0090 — Date assessment completed.

For example: Suppose a therapist is completing the assessment for a therapy-only patient. Your agency can opt to have an office nurse provide the high risk medication education over the phone to the patient.

Keep an Eye on Drug Effectiveness

OASIS item M2015 — Patient/Caregiver Drug Education Intervention asks whether the patient or caregiver was instructed to monitor the effectiveness of drug therapy, adverse drug reactions, and significant side effects at the time of or at any time since the previous OASIS assessment. Agency staff or another health care provider can provide this instruction, but it must cover how and when to report any problems that might occur

You’ll complete this item at transfer to inpatient and discharge not to inpatient.

Responses options for this item include:

• 0 — No
• 1 — Yes
• NA — Patient not taking any drugs.

Family and paid or volunteer workers including assistive living facilities and personal care homes are all considered caregivers for this item, according to the CMS training module.

In order to respond “Yes” to this item, your agency staff or another health care provider must provide education and assess the patient’s understanding of that education. This education must involve more than simply handing the patient a medication information sheet, CMS says. Patients should also have an opportunity to ask questions. The patient’s physician, pharmacist, or diabetic educator are all capable of providing this education.

After the medication education, patients or caregivers should know how to monitor whether the drug is accomplishing its expected purpose.

For example: If your patient is on heart failure medication, the education would include teaching the patient how and why to perform daily weights, monitoring for peripheral edema, and watching for shortness of breath as signs and symptoms that the heart failure medication is effective or not effective, CMS says in the training.

You should also teach patients and caregivers how to monitor and recognize signs and symptoms of potential drug reactions and side effects.

For example: A rash could be an allergic reaction to a new medication, CMS says. Or positional dizziness could be a reaction to a new hypertensive medication.

Tip: Teach patients and caregivers to watch for drug effectiveness and reactions of all their medications — not just high risk, CMS says. This should include prescription drugs as well as over-the-counter medications and by any route (oral, topical, inhalant, etc.).

For example: You’ll need to instruct a heart failure patient with a respiratory infection on the fact that developing a cough could be a side effect of a angiotensin receptor blocker and should be reported to the physician or cardiologist, CMS says. The patient or caregiver also needs to have the appropriate contact phone numbers in an accessible location.

Select the Correct Response

Consider the following criteria outlined in the CMS online training when deciding how to answer M2015.

Select response “NA” when:

The patient is not currently taking any drugs including prescribed, over the counter, or oxygen.

Select response “0 ― No” when:

Education did not cover all of the following for all medications:

• How to monitor the drug effectiveness;
• Potential side effects and drug reactions; and
• What, when, and how to report.

Tip: If you choose to answer “No” to this item, be sure to document why the patient didn’t receive the education.

Select response “1 ― Yes” when:

Your patient’s education occurred at or since the last OASIS was completed and included all of the following:

• How to monitor the drug effectiveness
• Potential side effects and drug reactions
• What, when and how to report

Tip: At recertification, if the assessing clinician determines and documents the patient and/or caregiver’s retention of prior teaching of all the required knowledge related to all medications, it’s appropriate to choose “Yes” for this item, CMS says. Just be sure to document these findings in the clinical note.