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M1830: Don't Count on Interviews to Assess Bathing Ability

Published on Sat Jan 01, 2011

Are time constraints negatively impacting your agency's bottom line?

You can earn up to six case mix points -- and more than $300 -- for patients who need assistance with bathing. But failing to take the time to accurately assess this activity can leave your agency missing out on this reimbursement opportunity. Try these expert tips to make sure you're painting an accurate picture of each patient's bathing ability.

Establish the Basics

OASIS item M1380 asks you to assess your patient's ability to wash her entire body safely.

Your response options for M1380 are:

0 -- Able to bathe self in shower or tub independently, including getting in and out of tub/shower;

1 -- With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower;

2 -- Able to bathe in shower or tub with the intermittent assistance of another person:

a) for intermittent supervision or encouragement or reminders, OR

b) to get in and out of the shower or tub, OR

c) for washing difficult to reach areas.

3 -- Able to participate in bathing self in shower or tub, but requires presence or another person throughout the bath for assistance or supervision;

4 -- Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode;

5 -- Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath; and

6 -- Unable to participate effectively in bathing and is bathed totally by another person.

You should complete M1830 at start of care, resumption of care, follow-up, and discharge.

When answering M1830, you're assessing the patient's ability to bathe himself safely, not desire or compliance, says Patricia Jump, president of Acorn's End Training & Consulting in Rice Lake, Wis.

Tip: Many tasks you might consider part of taking a bath are not part of this OASIS item, Jump says. For example, when responding to this item you shouldn't consider your patient's ability to perform bathing-related tasks, such as gathering supplies, preparing the bath water, shampooing her hair, or drying off after the bath, she says.

Accurate Assessments Depend on Demonstrations

To respond accurately to M1830, it's essential to actually have the client demonstrate getting into and out of the tub rather than just accepting her word regarding bathing ability, Jump says. "Many clinicians report they are only allowed a short amount of time to complete the visit and it's not realistic for them to have the client demonstrate all that should be demonstrated. Unfortunately this often results in inaccurate OASIS answers that can actually negatively impact reimbursement and ultimately the provider's bottom line," she warns.

To accurately assess the patient's bathing ability, rate him prior to any intervention, Jump recommends. For example, if you determine that his ability would improve with the use of adaptive equipment and he doesn't have such equipment currently, don't provide the equipment and then rate his ability.

Instead, choose the response that best fits at the time of the assessment, Jump says. If your patient then obtains the equipment and his ability improves, capture this improvement at the next OASIS assessment. Clinical documentation can report the intervention and the improvement right away, but the OASIS would not capture this until the subsequent OASIS assessment. This is a good thing, since the improvement will show up on your agency's outcome report, she says.

Consider Environmental Barriers to Bathing

It's important to keep in mind that your patient's environment can impact her ability to complete a bath, Jump says. For example, if her tub or shower is nonfunctioning or not safe, then she is unable to bathe in the tub or shower. This means only response "4," "5," or "6" would apply, depending on the patient's ability to participate in bathing activities outside the tub or shower.

Likewise if there is a medical restriction, your patient's bathing ability may be impacted. For example, if he is restricted from climbing stairs and the only tub or shower is upstairs, at best this patient is a response "4."

Example: "I once had a client who did fine getting into the tub with assistance while he was in the hospital, but his only way to do that was to get to the tub via wheelchair. Once he was home, he discovered his wheelchair could not fit through the bathroom door. Therefore, this client was not able to safely bathe in his tub," Jump says.

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