Home Health Coding and OASIS Expert

Published on Tue Dec 08, 2015 PDF

Don’t put CDC guidance aside, despite re-worked vaccine items.

The four OASIS influenza and Pneumococcal vaccine items will support items the Centers for Medicare & Medicaid Services will consider under Value-Based Purchasing. Make certain you’re answering these items correctly, or risk a negative impact on you reimbursement.

OASIS-C1 made these unnecessarily complex vaccine items much more straightforward, but you’ll still need to brush up on the vaccine reporting details to make certain your data collection is accurate. Consider these pointers from Sharon Litwin, RN, BS, MHA, with 5 Star Consultants in Camdenton, Mo.

M1041 — Influenza Vaccine Data Collection Period

This item is much easier in OASIS-C1 than it was previously, Litwin said during the recent Audio Educator audioconference “OASIS-C1 — A Complex Assessment Easily Explained.”

With a revised title and clarified time period for reporting, this item is much easier to answer. The intent of M1041 is to determine whether the patient was receiving services from your agency during the time period for which influenza vaccine data are collected (Oct. 1 to March 1).

The question has changed to “Does this episode of care (SOC/ROC to Transfer/Discharge) include any dates on or between October 1st and March 31^st?”

The new question format simplifies the time period under consideration, Litwin said. Calculating this was really difficult to do in the old OASIS-C, she said.

Answer “0 — No” and you’ll skip to M1051. Answer “1 — Yes” and you’ll advance to M1046.

M1046 — Influenza Vaccine Received

Simplified OASIS item M1046 now asks “Did the patient receive the influenza vaccine for this year’s flu season?”

This item now simply asks whether the patient did or did not receive influenza vaccine from any source, Litwin said.

Your potential answers to this item 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

Scenario: Your agency held a flu clinic at a local senior center where you provided vaccines and did roster billing. You’re admitting a new patient on Nov. 15^th and you notice that she received her flu vaccine at the clinic you held Oct. 15. How would you answer M1046?

Answer: You can answer “2 — Yes; received from your agency during a prior episode of care (SOC/ROC to Transfer/Discharge)” for this patient, Litwin said.

This answer is true even if the patient had the flu vaccine prior to Oct. 1, points out Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10-CM Trainer/Ambassador of Selman-Holman & Associates, LLC, CoDR — Coding Done Right and Code Pro University in Denton, Texas.

Suppose you’re completing the OASIS in the same scenario described above, except that the new patient received the vaccine at the clinic your agency held on Sept. 17. You’ll still the answer M1046 “2,” Selman-Holman says. “The flu vaccine does not have to be given between Oct. 1 and March 31. What triggers the need to answer M1046 is whether any dates in your outcome or care episode are included in the measurement time frame of Oct. 1 and March 31.”

M1051 — Pneumococcal Vaccine

The pneumococcal vaccine items are also easier to answer in OASIS-C1. Item M1051 asks the simple yes or no question “Has the patient ever received the pneumococcal vaccine (for example, pneumovax)?”

New: Limiting specifics like “during this episode of care” and “from your agency” are no longer important to your answer selection for this item.

M1056 — Reason Pneumococcal Vaccine not received

Answering “0 No” to M1051 moves you forward to this item. Here, you’ll specify the reason your patient has never received the pneumococcal vaccine. Your response options are:

1 — Offered and declined

2 — Assessed and determined to have medical contraindication(s)

3 — Not indicated; patient does not meet age/condition guidelines for Pneumococcal Vaccine

4 — None of the above

Although references to the Centers for Disease Control and Prevention recommendations are no longer included in this item, it’s important to make certain clinicians are up to speed on the current guidelines, Litwin said.

Scenario: Your new patient’s physician has ordered your agency not to provide her with the pneumococcal vaccine for reasons other than those included in the CDC’s list of medical contraindications. How should you answer M1056?

Answer: Choose response “2 — Assessed and determined to have medical contraindication(s)” for this patient. This is the appropriate response when the clinician confirms with the physician that the patient is medically restricted from take the vaccine for any reason.

Note: Order a recording or transcript of Litwin’s audio conference here: www.audioeducator.com/home-health/oasis-c1-08-18-2015.html.