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OASIS Alert

Assessment:

Mistakes Happen - But Don't Let Them Cost You

Published on Wed Jan 05, 2005

Follow these tips to M0550 accuracy.

Every time you miss an ostomy when completing an OASIS assessment, you lose at least $200.
 
M0550 (Ostomy for bowel elimination) is one of the OASIS questions that adds points to the clinical severity domain of the home health resource group. It's also a question that is pretty straightforward, notes consultant Patricia Jump, president of Acorn's End Training & Consulting in Stewartville, MN.

Tip: Include a question on the referral form asking whether the patient has an ostomy. If the answer is yes, have a trigger question to determine if the hospital stay was related to the ostomy, Jump recommends.

M0550 asks the clinician if the patient has an ostomy - any kind of colostomy or ileostomy - for bowel elimination that (within the last 14 days) was either related to an inpatient facility stay or required a change in medical or treatment regimen. If the patient does not have an ostomy for bowel elimination, the correct answer is "0."

Caution: Just because the referral form doesn't mention an ostomy, don't assume the patient doesn't have one, experts say. And patients who have a problem-free ostomy may not think to mention it.

Best bet: The easiest way to find out about an ostomy is simply to ask the patient if she has one. The patient may volunteer the information when you ask about bowel incontinence for M0540. Or you may see ostomy equipment in the patient's room or bathroom during your visit.
 
If the patient does have an ostomy, determine whether the patient has had recent problems with it. If there have not been recent problems, answer "1" on M0550.
 
If there was an ostomy-related inpatient stay or change in medical or treatment regimen within the 14 days before admission to home health, the correct answer is "2."

Hospital admission for diarrhea would be considered an ostomy-related stay, the Centers for Medicare & Medicaid Services says in an OASIS item question-and-answer.
 
Answering either 1 or 2 on M0550 will add 10 points to the clinical severity domain on the HHRG and add at least $200 to the reimbursement for the episode.

Mistake: If the patient had an ostomy in the past but it has been reversed, do not count this as an ostomy at the time of assessment, CMS says in the M0550 response-specific instructions.

Don't overlook the related patient care issues an ostomy raises, Jump reminds clinicians:

  • If an ostomy is present, be sure it is reflected in the diagnoses, assessment and, if indicated, on the nursing care plan.
  • If the patient has an ostomy, part of the assessment should include checking skin integrity around the ostomy. If needed, you should also address this in the care plan.
     
  • The presence of an ostomy should trigger questions about diet and hydration.

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