True or False? Even if a patient can communicate with you and his family fluently using American Sign Language or writing, unless he can actually talk you still must answer "5" (nonresponsive and unable to speak) for M0410. True. Even though it's not intuitive, M0410 focuses on hearing and speaking, not on ability to communicate, OASIS experts say. And nonverbal language, whether signed or written, isn't considered verbal expression of language, explains the Centers for Medicare & Medicaid Services in the question information in Chapter 8 of the OASIS Implementation Manual. But augmented speech, such as esophageal speech or an electrolarynx, is considered verbal expression. It's not that general communication ability isn't important, it's just not addressed in M0410, CMS reminded OASIS Education Coordinators at the April 2003 conference in New Orleans. Focus instead on speech and verbal expression, and record general communication ability elsewhere in the clinical record, CMS recommended.