OASIS Alert

Q: The home health agency I work for requires clinicians to answer "Yes" to M0440 (Does the patient have a skin lesion or open wound?) on all patients we assess. The explanation I've received is that everyone has at least a freckle or spot of some kind, and these are all considered skin lesions. But unless the lesion or wound is part of another OASIS question (like an ulcer or surgical wound) we don't record any explanation for why we answered "Yes." Should I be concerned about this practice?

A: Even though it is likely that every patient would fit into the "Yes" category on M0440, "I would be hesitant to make a policy requiring this answer," because it appears that you are marking a response without regard to a patient assessment, cautions OASIS expert Linda Krulish with Redmond, WA-based Home Therapy Services. A better way to word the policy might be "Every patient who is identified as having a skin lesion -- including a mole, freckle, scar, etc. -- should be marked 'Yes,' recognizing that this might be a majority or all of our patients," she suggests.

In the definition of M0440 in Chapter 8 of the OASIS Manual, the Centers for Medicare & Medicaid Services explains that "a lesion is a broad term to describe an area of pathologically altered tissue." Because scars, moles, freckles and rashes are considered lesions, most patients will have something that requires an affirmative answer on M0440. "I have not come across a patient who didn't require a 'Yes' in M0440," Krulish reports.

Also, some explanation of the M0440 answer is necessary, though it need not be complicated or time-consuming, Krulish tells Eli. OASIS doesn't require the clinician to include further details about every lesion. But since you are performing a comprehensive assessment it would make sense to clarify your answer, Krulish says, especially regarding whether the lesion identified is "currently problematic."

One way to do this is to include cues on the assessment forms, Krulish tells Eli.

Example: Just after M0440, the form could ask the clinician to choose one of two possible explanations for the answer given: either "skin lesions reported in M0440 include those requiring current assessment" (and an accompanying diagram or table on which to mark the location) or "lesions reported in M0440 include only healed lesions, scars or other areas of pathologically altered tissue that don't require current assessment or treatment." The clinician can simply check one of the two boxes and have the explanation you need, Krulish suggests.