Home Health Coding and OASIS Expert

Reorganization takes the guesswork out of vaccine items.

The flu vaccine OASIS questions have tripped up countless clinicians over the years. As of Jan. 1, 2015, answering these items will be much closer to a walk in the park.

Old way: Under OASIS-C, you needed to ask three questions before you could select the right response to M1040 — Did the patient receive the influenza vaccine from your agency for this year’s influenza season (October 1 through March 31) during this episode of care?

First, you needed to determine what quality care episode the transfer/discharge was addressing. Next, you needed to figure out whether a flu season occurred within the care episode. And finally, if a flu season did occur within the care episode, you needed to know whether the patient received a flu vaccination from a clinician employed with your agency during that quality care episode.

Once you worked your way through all of that, if you determined that you hadn’t provided the patient with his flu vaccine, you needed to move on to M1045 — Reason Influenza Vaccine not received and select a response that explained why you didn’t vaccinate.

New way: When you transition to the OASIS-C1 on Jan. 1, a new approach helps streamline the process of answering the flu vaccine items.

Renumbered item M1041 — Influenza Vaccine Data Collection Period asks whether this episode of care (SOC/ROC to Transfer/Discharge) includes any dates on or between Oct. 1 and March 31. Where you previously had to do the legwork yourself to figure out whether a flu season had occurred during the episode of care, the newly reworked item clarifies the time period for reporting, said Sharon Litwin, RN, BS, MHA with 5 Star Consultants in Camdenton, Mo.

Keep in mind that the flu season is not actually Oct. 1 through March 31. Each year’s flu season dates are determined by the Centers for Disease Control. The dates specified in this OASIS item are the time frame measured by this item.

Look for New Intent

The new number and wording for this item aren’t the only changes in store for M1041. The item intent will also change. M1040 was designed to identify whether a patient received an influenza vaccine for the current influenza season during the current episode of care.

Revised item M1041 is designed to identify whether the patient was receiving services from your home health agency during the time period for which influenza vaccine data are collected — Oct. 1 to March 31.

This is a “gateway item,” said Linda Krulish, PT, MHS, COS-C, president of Redmond, Wash.-based OASIS Answers during the Centers for Medicare & Medicaid Services OASIS-C1 implementation webinar. M1041 will filter out patients that won’t go into calculating flu vaccine process measures.

Look for a Simplified M1046

If the episode of care does fall during the time frame under consideration in M1041, you’ll move onto renumbered item M1046.

Old item M1045 asked you to indicate the reason the patient didn’t receive the flu vaccine from your agency. But M1046 asks you to indicate whether the patient received the vaccine for this year’s flu season. Your options include:

1 — Yes; received from your agency during this episode of care (SOC/ROC to Transfer/Discharge)
2 — Yes; received from your agency during a prior episode of care (SOC/ROC to Transfer/Discharge)
3 — Yes; received from another healthcare provider (for example, physician, pharmacist)
4 — No; patient offered and declined
5 — No; patient assessed and determined to have medical contraindication(s)
6 — No; not indicated — patient doesn’t meet age/condition guidelines for influenza vaccine
7 — No; inability to obtain due to declared shortage
8 — No; patient did not receive vaccine due to reasons other than those listed in responses 4-7

Previously, many agencies were confused about what to choose in different circumstances, Litwin said during the recent Eli-sponsored audioconference OASIS-C1/ICD-9: Are You Ready? The revisions and reorganization to this item make the options more clear.

How Would You Answer this Scenario?

Suppose you’re discharging a patient on May 1, 2015. The SOC for this patient was Oct. 15, 2014, followed by three recerts and no transfers. Clinical documentation indicates that the patient received her influenza vaccine from her neighborhood pharmacist on Oct. 7, 2014. How would you answer M1041 and M1046?

The correct response to M1041 is “1 — Yes,” said Krulish. The episode of care began on Oct. 15, 2014 and ended on May 1, 2015, so the episode of care does include dates that fall into the reportable range.

Your M1046 response for this patient would be 3 — Yes; received from another healthcare provider (for example, physician, pharmacist), Krulish said. Your patient received the flu vaccine for the current flu season from her pharmacist, not your agency.

Note: Order a recording or transcript of OASIS-C1/ICD-9: Are You Ready? here: www.audioeducator.com/home-health/are-you-ready-for-oasis-c1-11-13-2014.html. Listen to the CMS webinar here: https://webinar.cms.hhs.gov/oasisc1-archive (warning: audio).