OASIS Alert

You can answer M0390 even when your patients can't.

Scenario: During her assessment, a clinician realizes her patient suffers from dementia that makes him unable to answer questions related to his vision. When she asks him to read his medication label, he either doesn't respond or responds by talking about a completely different topic. How should the clinician respond to M0390?

Answer: When a patient is cognitively impaired to the point that he can't appropriately respond to questions, the clinician must observe how he functions in his environment, according to the Centers for Medicare & Medicaid Services. Rather than relying on the patient's past history or what someone else might have noticed, the clinician should watch how the patient reacts when he needs to see something.

For instance, you could test a patient's visual acuity by placing a plate of food in front of him. If the patient quickly and easily finds his fork or spoon, you know his vision hasn't deteroriated. Similarly, you could ask him to call someone to see if he easily finds the telephone, or put a new shirt on him to see if he can locate the buttons.

And, if the patient passes these tests, then you would report him as a "0-Normal vision," CMS explained in a July 2008 clarification posted on the OASIS Certificate & Competency Board.

Bottom line: Even if your patient can't voice his ability to see his medication labels, you can determine whether his vision is impaired just by paying close attention to how well he functions at home.

Note: The OCCB's July 2008 OASIS Q&As are at http://www.oasiscertificate.org on the "Resources" page.