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OASIS Alert

Reimbursement:

M0490 Downcoding Can Cost You Hundreds

Published on Thu Jan 01, 2004

Five points may not seem like much, but when it bumps the clinical severity level up a notch it adds more than $200 to the episode reimbursement.

To improve your M0490 accuracy, try these tips, suggested by Laura Gramenelles speaking at a recent Eli teleconference, "Strategies for OASIS Precision:"

  • For clinician consistency, use the examples suggested in the question to assess the patient's respiratory status - while dressing, using the commode or bedpan, walking 20 feet, eating or conversing.

  • During an inservice or other staff meeting, come prepared with several strings that are cut to 20 feet. Team up and have one person on the team walk from a starting point to what they estimate is 20 feet. Then using the string, the partner can see how close she came. Some people are quite accurate, but others might be way off, she said. Those who need practice can take a string home with them and work on developing a better idea of the distance they need to have the patient walk.

  • Ask the patient to show you the bathroom or bedroom so you can see the patient walking a distance you estimate to be 20 feet, meanwhile you can assess other M0 items.

  • While you're talking about other things, note whether the patient needs to stop frequently to catch her breath, even at rest.

  • If the patient is on continuous oxygen, you must evaluate for dyspnea while the patient is using oxygen.

  • If the patient uses oxygen intermittently, you must assess for shortness of breath when she is not using the oxygen.

  • Document heart rate and respiratory rate both at rest and with exertion to give a clearer picture of the patient.

  • Document whether the patient was or was not using oxygen, and any other specifics of your assessment, such as distance and breaks the patient takes, so the next clinician can be consistent with your assessment and anyone reviewing the record can understand the exact situation.

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