OASIS Alert

Don't be misled M0680 really measures mobility, not toileting.

M0680 asks clinicians to assess the patient's ability to get to and from the toilet or bedside commode safely. As one of the Home Health Compare outcomes and as a source of points in the patient's functional status domain, it's an OASIS item you need to understand.

This question is about function, rather than about incontinence, instructs consultant Beth Carpenter with Lake Barrington, IL-based Beth Carpenter & Associates. As long as clinicians keep that difference in mind, there should not be a problem, she tells Eli.

Tip: When answering this item, focus on the patient's mobility. Patients who have trouble knowing when they need to go to the bathroom or who have difficulty with undressing may still score at the highest level on toileting. M0680 excludes personal hygiene and management of clothing when toileting, according to the OASIS Implementation Manual.

Clinicians have five different options to describe the patient's current ability, ranging from "0" (Able to go to and from the toilet independently with or without a device) to "4" (Is totally dependent in toileting). Note that on M0680, unlike some of the other OASIS items, using a device to complete the activity still places the patient in the highest functional category.

Although the question may seem to duplicate the ambulation assessment in M0700, it's really more specific to the patient's environment, explains OASIS expert Linda Krulish with Home Therapy Services in Redmond, WA. Getting to and from the toilet could require more strength or agility than walking across the room. A patient's bathroom may be some distance from her bed or even on another floor, she notes, and there may be obstacles in the way.

Look for situations that would intermittently interefere, such as meds, poor lighting, caregiver absence or pain, reminds LarsonAllen Health Care Group senior consultant Linda Rutman.

Time-Saving Trick: You can combine this question with others involving getting around, Krulish suggests, such as asking the patient to walk to the bathroom to assess both M0680 and M0700.

But be sure to observe and not just interview, experts stress. And document any concerns such as the need for assistive devices or reminders, so they can be included in your plan of care.

Responses two, three and four (where the patient can't get to and from the toilet even with assistance) add points for Medicare reimbursement, Krulish notes. But it's the same three points for any of these three responses.

Assess M0680 even it the patient has a catheter or ostomy. The biggest source of confusion is that M0680 is not intended to include much of what clinicians consider "toileting," Krulish reports. Agencies don't measure bathing only by whether the patient can get to the bathroom, and "we need a better outcome measure for toileting because it's such a critical part of independent living," she adds.