Outcome And ASsessment Information Set Gina Croft,MPT April 27, 2009

Outcome And ASsessmentInformation Set

Gina Croft,MPTApril 27, 2009

Objectives

• At the conclusion of the training, the clinical staff will be able to:– Identify the comprehensive assessment

requirements (patients, time points, procedures.)– Discuss the meaning of each OASIS item– Discuss the conventions (rules) to observe in

completing OASIS items

– Describe the assessment strategies to utilize for collecting OASIS data

– Accurately conduct and document a start of care assessment

– Accurately conduct and document a follow-up/discharge assessment

OASIS

• Created by CMS to be the formal measure in home health to determine if pts in this setting were getting better

• Never meant to be the payment tool• Money M0 questions• Tool for collecting data at start of care • Using that data to provide the foundation for

how we plan care

• Are we using this tool as a team? • Everyone has a stake as to whether or not the

patient gets better – not just the admitting persons’ job– success/failure to achieve positive outcomes is a

team effort!

• Admission is a record of patient’s story– This visit gets a lot of attention because it drives

reimbursement (not just about the admission!)

• Admission compared to end of episode but also what are we doing in the middle; are we thinking about OASIS scores during our treatments?

• What is improvement? – Are they any better from beginning to end? – Goal is not to fix pts – Ie: Moving from 3 to 2 shows improvement even

though they still need help, they may not need as much

• Chapter 8 instructions– Understand how to pick answers

• Need to stay current; always changing• Most current guidance from CMS

Start of Care

• Patient Tracking Sheet:– Items M0010, 0012, 0014, 0016, 0020, 0030,

0032, 0040, 0050, 0060, 0063, 0064, 0065, 0066, 0069, 0072, 0140, 0150: self explanatory or agency will supply proper id numbers.

• Clinical Record Items– M080: who is filling out OASIS– M090: date it is being completed– M0100: mark only one response

Episode Timing: Early or Late?

• M0110– Identifies the placement of the current MCR

payment episode in the patient’s current sequence of adjacent MCR payment episodes.

– “Early” means the only episode OR the first or second episode in a sequence of adjacent episodes

– “Later” means the third or later episode in a sequence of adjacent episodes.

Why Early vs Late

• Had to do with cost info– Expenses are higher in later episodes

• Higher expenses = more money• Autocorrect feature: – if marked early when it was really a late episode it

will be corrected automatically• Some agencies were holding therapy until

episode 3 or later (yes there are unethical folks in homecare!)

• What does this mean for the rest of us? If we are providing therapy in a later episode, we need to be clear that is medically necessary

M0175 Discharged from where?

• Identifies whether the pt has been dc’d from an inpatient facility within the last 14 days

Response-Specific Instructions

• Mark all that apply. May have come out of the hospital and rehab facility within the past 14 days

• Rehab facility defined as a freestanding rehab hospital or a rehab bed in a rehab distinct part unit of a general acute care hospital

• SNF is a MCR certified nursing facility where the patient received a skilled level of care under the MCR Part A benefit

SNF

• Determine the following:– Was patient dc’d from MCR certified SNF? If so

then– While in the SNF was patient receiving skilled care

under MCR Part A? if so then– Was the patient receiving skilled care under the

MCR Part A benefit up to 14 days prior to admission to home health care?

– If all 3 criteria then select response #3

M0180 Discharge Date

• Identifies the most recent discharge from an inpatient facility (within 14 days) [14 days encompasses the 2 week period immediately preceding the start/resumption of care]

• Use the most recent date of discharge from any inpatient facility

M0190: Inpatient Diagnosis

• Identifies diagnosis(es) for which patient was receiving treatment in an inpatient facility within the past 14 days


• Include only those diagnoses that required treatment during inpatient stay

• If a diagnosis was not treated during an inpatient admission, don’t list it (ie: pt has long standing history of OA but was hospitalized for peptic ulcer disease)

• This is the diagnosis for which the patient received treatment

• No surgical codes: list the underlying diagnosis that was surgically treated.

Coding

• Fundamental pieces of coding– we own the coding process because it is what

describes the patient– Primary diagnosis selected looks at patient in their

entirety inclusive of any other services going out to the home and the main reason we are there

•

M0200: Medical or Treatment Regimen change within past 14 days• Identifies if any change has occurred to the

patient’s treatment regimen, health care services, or meds due to a new diagnosis or exacerbation of an existing diagnosis within past 14 days

M0210: Medical Diagnoses

• Identifies the diagnosis(es) that have caused an addition or change to the patient’s treatment regimen, health care services received, or meds within the past 14 days

• Can be a new diagnosis or an exacerbation to an existing condition

M0220

• Identifies existence of condition(s) prior to medical regimen change or inpatient stay within past 14 days.

• Past health history– Interview patient/caregiver. May call MD to get add’l

info. – Determine any conditions existing before the

inpatient facility stay or before the change in medical/treatment regimen

• At DC omit NA and UK

M0230/240/246

• Identifies each diagnosis for which patient is receiving home care and its ICD-9-CM code

• Each diagnoses categorized according to its severity

• Primary diagnosis (M0230) should be the main condition/reason for providing home care

• Secondary diagnoses in M0240 are defined as “all conditions that coexisted at the time plan of care was established, or which developed subsequently, or affect the treatment of care”

• In general, M0240 should include not only conditions actively addressed in the patient’s plan of care but also any co-morbidity affecting the patient’s responsiveness to treatment and rehab prognosis, even if the condition is not the focus of any home health treatment itself. Avoid listing diagnoses that are of mere historical interest and without impact on patient progress or outcome

Case mix diagnosis

• Diagnosis that gives a patient a score for Medicare Home Health PPS case-mix group assignment

• May be the primary diagnosis, “other” diagnosis, or a manifestation associated with a primary or other diagnosis

Assessment Strategies

• M0230/0240 Primary and Other Diagnoses– Interview patient/caregiver to obtain past health

history; additional info from MD– Review current meds and other treatment

approaches– Determine if add’l diagnoses are suggested by

current treatment regimen and verify this info with patient/cg/MD

• Assessing severity includes review of presenting signs and symptoms, type and number of meds, frequency of treatment readjustments, and frequency of contact with health care provider

• Inquire about the degree to which each condition limits daily activities

• Assess patient to determine if symptoms are controlled by current treatments

• Clarify which diagnoses/symptoms have been poorly controlled in the recent past

M0250: Therapies

• Identifies whether patient is receiving any of the listed therapies at home, whether or not the home health agency is administering the therapy

Assessment Strategies• Determine from pt/cg interview, nutritional

assessment, review of PMH and referral orders

• Assessment of hydration status or nutritional status may result in an order for such therapy/ies

M0260 Overall Prognosis

• Identifies the patient’s expected overall prognosis for recovery at the start of this home care episode


• Interview for PMH and observe current health status

• Consider diagnosis and referring physician’s expectations for this patient

• Based on this info make informed judgment regarding overall prognosis

M0270: Rehab Prognosis

• Identifies the patient’s expected prognosis for functional status improvement at the start of this episode of home care


• Interview for PMH and observe the current functional status

• Consider diagnosis and referring physician’s expectations for this patient

• Based on info received, make informed judgment regarding rehab prognosis

M0280: Life Expectancy

• Identifies those patients for whom life expectancy is fewer than 6 months

• Note: A DNR does not need to be in place


• Interview the pt/cg to obtain PMH• Observe current health status• Consider medical diagnosis and referring

physician’s expectations for patient• If the patient is frail and highly dependent on

others, ask the family whether the physician has informed them about life expectancy

• Based on info received make an informed judgment regarding life expectancy

M0290: High Risk Factors

• Identifies specific factors that may exert a high impact on the patient’s health status and ability to recover from this illness

Response Specific Instructions

• Utilize agency assessment guidelines and informed professional decision making.

• Consider amount and length of exposure when responding (Ie: smoking 1 cig/month may not be considered a high risk factor)

• Specific definitions for each of these factors do not exist


• Interview pt/cg for PMH• Observe environment and current health

status

M0300: Current Residence

• Identifies where the patient is residing during the current home care episode

• Observe the environment in which the visit is being conducted.

• Interview the pt/cg re: others living in the residence, their relationship to the patient and any services being provided

M0340: Lives with…

• Identifies who the patient is living with at this time, even if temporary

• Need to know in order to plan care and services

• Try to incorporate this question into the conversation, so the patient does not feel an investigation is being conducted

• Includes:– one family member or other designated caregiver

staying 24 hours/day with the patient even arrangement is temporary

• Excludes: – Part time or intermittent caregiver– Several family members or caregivers who make

up 24 hour shift

M0350: Assisting Persons…

• Identifies the individuals who provide assistance to the patient (no home health)

• “does anyone help you for any reason (personal care, household chores, errands, home maintenance, etc?) Who?

• Paid help includes:– Services purchased in board and care or ALFs– Agencies other than home care agency

• Paid help cont:– Other private or community services paid by

patient, family, special program or community funds

– Meals on wheels


• If patient mentions a friend or relative helping or coming to visit, interview to find out more about who helps patient, how often, what helpers do, etc. (applies to M0360, M0370, M0380)

• In obtaining PMH, interview to determine whether ADL/IADL assistance is needed.

• If so, request info on whether patient received assistance and from whom

M0360: Primary caregiver

• Identifies the person who is “in charge” of providing and coordinating the patient’s care.– case manager hired to oversee care, but who does

not provide any assistance is not considered the primary caregiver

– This person may employ others to provide direct assistance, in which case, paid help is considered the primary caregiver


• From M0350, it is known that the patient receives assistance.

• Interview to determine whom the patient considers to be the primary caregiver

• For example, “of the people who help you, is there one person who is ‘in charge’ of making sure things get done?” “Who would you call if you needed help or assistance?”

• Select “0-No one person” if:– The primary caregiver is the patient himself– There are multiple caregivers and each provides

varying amounts of assistance and no one of them is “in charge”

M0370: How often…

• Identifies the frequency of the help provided by the primary caregiver


• Ask, in various, ways, how often the primary caregiver provides various types of assistance

• Ie: “how often does your daughter come by? Does she go shopping for your every week? When she is here, does she do the laundry?

• As you proceed through the assessment (ADLs, IADLS) several opportunities arise to learn details of the help the patient receives

M0380: Type of Assist

• Identifies categories of assistance provided by the primary caregiver (from M0360)

• Not the type of help patient receives from all people who help

Response Specific

• 3: home repair and upkeep, mowing lawn, shoveling snow, painting

• 4: frequent visits, phone calls, going with patient on outings, church services, other events

• 5: takes patient to medical appointments, follows up with filling prescriptions or making subsequent appointments, etc

• 6&7: legal arrangements that exist for finance/health care


• Interview questions about types of assistance are likely to produce answers that relate to ADLs and IADLs

• More specific questions need to address other aspects of assistance

• At start of care, discussion of advance directives can provide info about existing legal arrangements for decision-making

M0390: Vision

• Identifies the patient’s ability to see and visually manage (function) within his/her environment

• Wearing corrective lenses if these are usually worn

• Magnifying glass is not an example of corrective lenses

• Reading glasses (drugstore kind) are

• Person is considered partially or severely impaired if:– Magnifying glass is used to see small print or med

labels– Does not regularly use glasses when he has them– Needs a different prescription for accurate

viewing– Limited field of vision creates safety risk with

mobility, etc

• Severely impaired if:– They are blind– Is nonresponsive (unable to voluntarily respond)

or unconscious


• In the health history interview, ask the patient about vision problems (ie: cataracts) and whether or not the patient uses glasses

• Observe ability to locate signature line on consent form, to count fingers at arm’s length and ability to differentiate between meds

• Be sensitive to requests to read as patient may not be able to read though vision is adequate

M0400: Hearing and Ability…

• Identifies the patients ability to hear and to understand spoken language, in the patient’s primary language.

• Evaluated with the patient wearing aids if he/she usually uses them

• Focus is on receptive communication, the hearing and understanding of spoken language.

• Response will be affected by ability to hear and process info (cognitive status)


• Interaction with the patient during the assessment process provides info

• If they use hearing aides make sure that they are in, have a battery and are turned on

• Determine if an interpreter is necessary and document the presence of this person

M0410: Speech…

• Identifies the patient’s ability to communicate verbally in the patient’s primary language

• Does not address sign language, writing, or by any nonverbal means

• Augmented speech (ie: trained esophageal speaker, electrolarynx) is considered verbal expression of language

M0420: Pain

• Identifies frequency with which pain interferes with patient’s activities, with treatment if prescribed

• Pain interferes with activity when the pain results in the activity being performed less often than otherwise desired, requires the patient to have add’l assist in performing the activity, or causes the activity to take longer to complete


• When reviewing meds, the presence of pain meds or joint disease provides opportunity to explore presence of pain, when the pain is most severe, activities with which the pain interferes, and the frequency of this interference with activity or movement

• Be careful not to overlook seemingly unimportant activities (ie: patient says they sit in chair all day and puts off going to the bathroom because it hurts too much to get up from chair or to walk)

• Evaluating ADLs and IADLs can provide info about pain

• Assess pain in non-verbal patients by observing facial expression, heart rate, respiratory rate, perspiration, pallor, pupil size, irritability, etc

• Treatment for pain (pharm or non-pharm) must be considered when evaluating whether pain interferes with activity or movement

M0430: Intractable Pain

• Identifies the presence of intractable pain, as defined in the item

• To be considered ‘intractable’ the pain must meet all 3 criteria listed in the item:– Not be easily relieved– Be present at least daily, and– Affect the patient’s quality of life as outlined in

the item wording

M0440: Skin Lesion…

• Identifies the presence of a skin lesion or open wound

• Lesion is a broad term used to describe an area of pathologically altered tissue

• Sores, skin tears, burns, ulcers, rashes, surgical incisions, crusts, etc are all considered lesions

• All alterations in skin integrity are considered to be lesions, except alterations that end in ‘ostomy’ or peripheral IV sites

• Persistent redness w/o break in skin is also considered skin lesion

• Pin sites, central lines, PICC lines, implanted fusion devices or venous access devices, surgical wounds with staples/sutures are all considered lesions/wounds

• All ostomies are excluded under this item


• Interview the patient to determine the existence of any known lesions

• Follow by visual inspection of the skin• Inspection may reveal additional areas on

which to focus interview questions• The comprehensive assessment should

include add’l documentation of lesion/wound location, size, appearance, status, drainage, etc, if applicable

M0445: Pressure Ulcer

• Identifies the presence of a pressure ulcer, defined as any lesion caused by unrelieved pressure resulting in tissue hypoxia and damage of the underlying tissue.

• Most often occur over bony prominences


• Interview for the presence of risk factors for pressure ulcers (ie: immobility, activity limitations, skin moisture, or incontinence, poor nutrition, limited sensory-perceptual ability)

• Inspect skin over bony prominences carefully• Important to differentiate pressure ulcers

from other types of skin lesions

• If not sure if wound fits the definition of pressure ulcer, contact MD for clarification

• Includes all current and active lesions that are a result of unrelieved pressure

• Includes previously healed stage 3 and 4 pressure ulcers

• Excludes previously healed stage 1 and 2 pressure ulcers, lesions not caused by pressure, pressure ulcer closed with muscle flap

M0450, 0460, 0464

• Current # of ulcers, staging, status of most problematic

M0468: Stasis Ulcer

• A response of yes identifies the pressure of an ulcer caused by inadequate venous circulation in the are affected (usually lower legs).

• Often associated with stasis dermatitis


• Interview for presence of circulatory disorders and lower extremity skin change in PMH

• Inspect skin carefully, esp legs• Differentiate stasis ulcer from other types of

skin lesions

M0470, 0474,0476

• Number, Ability to observe, status

M0482: Surgical Wound

• Identifies the presence of any wound resulting from a surgical procedure

• A wound that has completely healed (scar) no longer identified as a surgical wound


• During comprehensive head-to-toe assessment, if health history or diagnosis indicate recent surgical procedures performed on the integumentary system, inspect surgical sites

M0484, 0486, 0488

• # of wounds, visible, status

M0490: Short of Breath

• Identifies shortness of breath• Observe patient walk at least 20 feet (to

bathroom) simulate ADL. • If unable to walk observe movement by

transfer or within bed• Not level of exertion which causes a

noticeable shortness of breath

M0500 Respiratory Treatments

• Identifies any of the listed respiratory treatments being used by this patient in the home

• Does not include nebulizers, inhalers, bi-pap, etc

M0510 UTI

• Identifies treatment of UTI in past 14 days• Select YES if:– Has symptoms or a positive culture and treatment

prescribed– A patient is on prophylactic treatment and develops a

UTI• Select NO if:– Has symptoms or positive culture and no prescribed

treatment– Treatment ended more than 14 days ago

M0520: Urinary Incontinence…

• Identifies presence of urinary incontinence or condition that requires urinary catheterization of any type, including intermittent or indwelling

• The etiology of incontinence is not addressed in this item


• Review the urinary elimination pattern as you take health history

• Does patient admit having difficulty controlling the urine

• Is he/she embarrassed about needing to wear a pad so as to not wet clothing?

• Is a stroke patient using an external catheter• Be alert for an odor of urine

• If the patient received aide services for bathing and/or dressing, ask for input from the aide

• Incontinence may result from multiple causes:– Physiologic reasons– Cognitive impairments– Mobility problems

M0530: When…

• Identifies time of day when urinary incontinence occurs

• Timed voiding defers includes:• Actively practicing a timed voiding program

which results in no episodes of incontinence in the relevant past

• Timed voiding defers excludes:– Episodes of incontinence in spite of timed voiding– Timed voiding programs initiated with this visit

M0540: bowel incontinence

• Identifies how often the patient experiences bowel incontinence

• Refers to the frequency of a symptom not to the etiology of that symptom

• Does not address treatment of incontinence or constipation


• Review the bowel elimination pattern as you take the health history

• Observe the cleanliness around the toiled when you are in the bathroom

• Note any visible evidence of soiled clothing• As the patient if he/she has difficulty

controlling stools, has problems with soiling clothing, uncontrollable diarrhea, etc

• If patient has an aide question the aide about evidence of bowel incontinence at follow up time points

M0550: Ostomy

• Identifies presence of an ostomy for bowel elimination

• If so, whether the ostomy was related to a recent inpatient stay or a change in medical treatment plan


• Unless it is mentioned in the referral orders, interview the patient about the presence of an ostomy

M0560: Cognitive Functioning

• Identifies the patient’s current level of cognitive functioning

• Includes alertness, orientation, comprehension, concentration and immediate memory for simple commands


• The patient’s description of current illness, past health history, and ability to perform ADLs and IADLs allows the clinician to assess cognitive functioning through observation

• If the patient is having trouble remembering questions, ask if this is common or because a stranger is asking a lot of questions

• Does the patient have trouble remembering friends and/or relatives names?

• Does the patient forget to eat, bathe or get disoriented when walking or traveling around the neighborhood or city?

• Gather info from caregivers– Does patient need reminders to take meds or get

dressed?– Does he ask the same question or tell same story

multiple times?

• Ask patient to carry out a series of 2 or 3 simple instructions and observe response

M0507: Confused

• Identifies the time of day the patient is likely to be confused, if at all


• Info collected by report or observation• Observe patient’s response to questions

about current health status, past health history, symptoms, and ability to perform ADLs and IADLs

• Ask the patient whether or not he/she ever feels somewhat confused and under what circumstances that occurs

• Is there a change in attention span

• Has recent memory declined• Mild confusion can be masked in patients with

well-developed social skills, so careful assessment is needed

• Sleep habits, appetite changes, and weight changes are relevant to determining current mental status

• Family/caregivers can provide info

M0580: Anxious

• Identifies the frequency with which the patient feels anxious


• Info collected by observation or report• Observe posture, motor behavior, facial

expressions, affect and manner of speech• Ask:– Do you find yourself worrying about things?– Have feelings of nervousness?– Wake up at night with things on your mind?

• Prevalent in patients with chronic respiratory distress, so may be able to relate anxiety to increased respiratory difficulty

M0590: Depression

• Identifies presence of symptoms of depression


• Observe and interview patient, family/caregiver

• Observe mood, energy, affect• Check for antidepressant meds• Validate initial impressions with interview

questions (ie: “I noticed that... Can you describe your mood for me?”)

• Observe order and amount of light in the environment

• Observe type and condition of clothing• Note thought processes and behavior in the

patient’s responses• Sleep habits, appetite changes, and weight

changes are relevant to determining neuro/emotional status

M0610: Behaviors demo’d…

• Identifies specific behaviors which may reflect alterations in a patient’s cognitive or neuro/emotional status


• Observe patient for the presence of these behaviors throughout the entire assessment

• If present, validate the frequency of their occurrence

• In the health history, interview for the current presence of these behaviors at the stated frequency

• Consult with family or caregiver

Additional Tips

• Include in consideration in response 1 those with memory deficits who:– Require supervision of ADL/IADL for safe

performance or completion of task– Require supervision or assistance with medication

or equipment

• Include for consideration in response “2” those who:

• Demonstrate poor safety awareness (leave walker on other side of room and use furniture and walls for balance because “I don’t need it”, etc)

M0620: Frequency of Behavior…

• Identifies frequency of behavior problems which may reflect an alteration in a patient’s cognitive or neuro/emotional status.

• Behavior problems are not limited to only those listed in M0610

• Ie: wandering is included as an add’l behavior problem

• Any behavior of concern for the patient’s safety or social environment can be regarded as a problem behavior


• Observe patient for the presence of these behaviors throughout the entire assessment

• If present, validate the frequency• In the health history, interview for the

presence of these behaviors at the stated frequency, over a period of time sufficient to determine the current frequency of occurrence

M0630: Psychiatric Nursing

• Identifies whether the patient is receiving psychiatric nursing services at home as provided by a qualified psychiatric nurse

• Psychiatric nursing services address mental/emotional needs, a “qualified psychiatric nurse” is so qualified through education preparation or experience


• Review the current plan of care to determine whether such services are currently being provided

M0640: Grooming

• Identifies the patient’s ability to tend to personal hygiene needs, excluding bathing

• The prior column should describe the patient’s ability 14 days prior to the start (or resumption) of care visit.

• The focus for today’s assessment – the current” column - is on what the patient is able to do today

Response – Specific Instructions

• Grooming includes several activities• The frequency with which selected activities

are necessary (ie: washing face and hands vs fingernail care) must be considered in responding

• Patients able to do more frequently performed activities but unable to do less frequently performed activities should be considered to have more grooming ability

• Response 2 includes standby assistance or verbal cueing


• A combined observation/interview approach with the patient/caregiver is required to determine the most accurate response

• Observe the patient gathering equipment needed for grooming

• The patient can verbally report the procedure used for grooming and demo the motions utilized in grooming (ie: hand to head combing, hand to mouth feeding)

• Observe the general appearance of patient ( to assess grooming deficiencies)

• Verify upper extremity strength, coordination and manual dexterity to determine if the patient requires assist

• A poorly groomed patient who possesses the coordination, dexterity, ROM and cognitive/emotional status to perform grooming activities should be evaluated according to his/her ability to groom

• Assessment of “ability” includes consideration of:– Cognition, emotional and behavioral state

(alertness, comprehension, fear, anxiety)– Physical function– Safe completion of tasks (presence of

safety/adaptive equipment)– Medical restrictions (slings, immobilizers)– Activity limitations ( bed rest, joint replacement

with inability to climb stairs)

• Current clinical condition (limited ROM, edema, pain, paresis, paralysis, impaired balance, fall risk)

• Location of bathroom (restricted access, narrow doorways)

M0650: Dress upper body

• Identifies patient’s ability to dress upper body, including ability to obtain, put on and remove upper body clothing

• Prior column = 14 days prior to start of care• Current = today

Response Specific Instructions

• If the patient requires SBA (a “spotter”) to dress safely or requires verbal cueing/reminders then Response 2 applies


• Observe/interview approach required to determine the most accurate response for this item

• Ask the patient if he/she has difficulty dressing upper body

• Observe the patient’s general appearance and clothing to determine if they have been able to dress appropriately

• Opening and removing upper body garments during the physical assessment of the heart and lung provides an excellent opportunity to eval upper extremity ROM, coordination and manual dexterity needed for dressing

• Ask patient to demo body motions involved in dressing

• Assess ability to put on whatever clothing is routinely worn

• Determine physical and cognitive ability to safely retrieve, dress and undress upper body in clothing routinely worn by pt demo

• Protective and supportive devices such as a prosthesis, immobilizer, splint, cervical collar are also included

• Consider storage location of items and skills necessary to manage buttons, zippers, snaps, etc

• 0= independent, no human intervention required for completion of majority of dressing tasks

• 1=dependent on another person for set up, to obtain items for dressing

• 2=dependent on another person for at least min assist (SBA) or supervision (cueing reminders)

• 3=totally dependent on another person to accomplish upper body dressing

M0660: Dress lower body

• Identifies pt’s ability to dress lower body, including ability to obtain, put on and remove lower body clothing

• Observe spinal flexion, joint ROM, shoulder and UE strength, manual dexterity

• Protective and supportive devices such as prosthesis, immobilizer, splint, compression stockings, etc

• Refer to table for upper body dressing for scoring 0-4

M0670: Bathing

• Identifies pt’s ability to bathe entire body and the assistance required to safely bathe in shower or tub

• Show me how you wash your feet or your back. Observe the patient’s judgment, flexibility, coordination, balance, strength etc

• Note location of tub/shower and ability to get in/out


• The pt who bathes independently at the sink must be assessed in relation to his/her ability to bathe in tub or shower

• If requires SBA to bathe safely or requires VC/reminders then 2 or 3 apply depending on quantity of assist needed– 2=can step out to get cup of coffee and return

(intermittent supervision)– 3=unable to leave bathroom at all (constant

supervision)

• If pt medically restricted from stair climbing and tub/shower is upstairs, then pt is temporarily unable to bathe in tub/shower and scored a 4 or 5 depending on ability to participate

• If pt’s ability to transfer in/out of tub is the only bathing task requiring human assist then 0 or 1 would apply depending on need for devices

• Determine physical and cognitive ability to safely wash their body in tub/shower, regardless where or how the patient chooses to bathe

• Excludes:– Grooming tasks– Shampooing hair– Gathering supplies– Drying self– Transfer in/out of tub/shower– Willingness, compliance and patient preference

• Select Responses 0-3 if:– Able to get in and out of tub/shower by any safe

means with current bathroom and equipment setup regardless of whether they routinely do it

– Ignore item 2(b) from the item wording as the transfer is not considered when scoring this item

• Select Response 4 if:– Able to safely bathe self or participate in bathing

at any location but not in tub/shower– Tub/shower not functioning or not safe– Unable to get to the tub/shower location– Medical restrictions keep patient from using

tub/shower

• Select Response 5 if:– Unable to effectively participate in washing their

body regardless of location

M0680: Toileting

• Identifies the pt’s ability to safely get to and from toilet or bedside commode (BSC)

• This is an access question• Excludes personal hygiene and management

of clothing • Note ability to safely walk or use w/c to get to

the bathroom toilet or BSC


• Combined observation/interview approach with pt or cg

• Ask pt if he/she has any difficulty getting to/from toilet or BSC

• Observe during transfer and ambulation to determine if pt has difficulty with balance, strength, dexterity, pain etc

M0690: Transferring

• Identifies pt’s ability to safely transfer in a variety of situations

• Show me how you get on/off chair, move from bed to chair, get in/out of tub/shower, get on/off toilet/commode

• Note judgment, flexibility, coordination, balance, strength,


• Response 1 if safe transfers require:– Minimal human intervention (VC, SBA, CGA) but

no device OR– Device but no human intervention

• Response 2 if safe transfers require:– BOTH human intervention AND device AND– Patient can both bear weight AND pivot

• Able to bear weight refers to ability to support the majority of his/her body weight through any combo of weight bearing extremities

• Response 3 if safe transfers require:– Human intervention AND– Patient can either bear weight OR pivot, OR do

neither (lifted by another or by a mechanical lift device)

• If ability varies between the transfer activities listed, record the level of ability applicable to the majority of those activities

M0700: Ambulation

• Identifies the pt’s ability and type of assist required to safely ambulate or propel self in w/c over a variety of surfaces

• “walk with me”. If non-amb “show me how you can get around in your w/c”

• Go over most difficult surface maintaining pt safety

• Observe pt’s judgment, coordination, balance, strength,etc

• Note if use walls/furniture for support and assess if patient should use a walker or cane for safe ambulation

• Observe pts ability and safety on stairs• If chairfast, assess ability to propel w/c

independently whether manual or power w/c• A patient who demonstrates ability to take 1 or 2

steps to complete a transfer but is otherwise non-ambulatory should be considered chair fast

M0710: Feeding/Eating

• Identifies the pt’s ability to feed self meals, including process of eating, chewing and swallowing food

• Excludes evaluation of preparation of food items


• Meal “set up” includes activities such as mashing a potato, cutting up meat/veggies, pouring milk on cereal, opening milk carton, adding sugar to coffee, arranging food on the plate for ease of access

• During nutritional assessment, determine whether special preparations (pureeing, grinding) must occur for food to be swallowed

M0720: Meal Preparation

• Identifies pt’s physical, cognitive, and mental ability to plan and prepare meals, even if the patient does not routinely perform this task


• Response 1 indicates patient can intermittently prepare light meals

• Response 2 indicates pt cannot prepare light meals at all


• Ask pt about the ability to plan and prepare light meals even if this task is not routinely performed

• Does pt have cognitive ability to plan and prepare light meals (whether or not he/she currently does this)?

• Consider ability to select, retrieve, carry, prepare, and get items to table or cooking area for reheating a prepared meal

M0730: Transportation

• Identifies pt’s physical and mental ability to safely use a car, taxi or public transportation

• When you need to go to the doctor, how do you get there?

• How did you get home from the hospital?

M0740: Laundry

• Identifies pt’s physical, cognitive and mental ability to do laundry, even if the pt does not routinely perform this task

• Impacted by pt’s environment (washing machine on same floor, same building, etc)

• Ability to do laundry in his/her own environment should be considered

• Observe pt’s comprehension, judgment, coordination, balance, strength, lifting restrictions, weight bearing status and use all reported and observed info to assist in making inferences about ability to do laundry

M0750: Housekeeping

• Identifies physical, cognitive, and mental ability to perform both heavier and light housekeeping tasks, even if pt does not routinely carry out these activities

• During this period of recovery, how will your housekeeping get done?

• Considering how you feel, tell me what cleaning and housekeeping tasks you can do

• Note floor plan of home• Dusting, bed making, sweeping floors, doing

dishes, cleaning bathrooms

M0760: Shopping

• Identifies the physical, cognitive, and mental ability of pt to plan for, select and purchase items from a store even if the pt does not routinely go shopping

• How are meds, groceries, medical supplies obtained?

M0770: Telephone

• Identifies the ability of pt to answer the phone, dial number and effectively use the telephone to communicate

• Does pt have access to phone?• Show me how you use the phone

M0780: Meds

• Identifies pt’s ability to prepare and take oral meds reliably and safely and the type of assistance required to administer the correct dosage at appropriate times/intervals

• Focus is on what the patient is able to do, not on the pt’s compliance or willingness


• Observe patient opening meds• Ask pt to state the proper dosage for each med

and correct times for administration• The cognitive/mental status and functional

assessments contribute to determining the appropriate response for each item

• If pt’s ability to manage meds varies from med to med, consider total number of meds and total daily doses in determining what is true most of the time

M0790: Inhaled Meds

• Identifies patient’s ability to prepare and take all prescribed inhalant/mist medication reliably and safely and the type of assist required to administer the current dosage at the appropriate times/intervals

• The focus is on what the patient is able to do, not on the pt’s compliance and willingness


• Observe patient opening inhalant mist/meds and preparing any other equipment needed for administration.

• If it is not time for the med, ask pt to describe and demo steps for administering

• Includes:– Oxygen– Nebulizers– Metered dose devices

M0800: Injectable Meds

• Identifies the pt’s ability to prepare and take all injectable meds reliably and safely and the type of assist required to administer the correct dosage at the proper times

• Focus on what they can do not compliance or willingness


• Observe pt preparing the injectable meds– Obtaining it, preparing it (opening, drawing up),

selecting correct site, proper disposal of supplies

• If not time, ask pt to demo or describe steps for administration

M0810: Equipment Mgmt

• Identifies the pt’s ability to set up, monitor and change equipment reliably and safely and amount of assist required from another person– Adding fluids and meds, cleaning, storing,

disposing of equipment and supplies


• Observe pt setting up and changing equipment

• Ask pt to describe the steps for monitoring and changing equipment if observation is not possible

M0820: CG mgmt of equip

• Identifies the cg’s ability to set up, monitor and change equipment reliably and safely

• Focus is on what the cg can do not on compliance or willingness

• Same strategy as in pt mgmt of equip

M0826: Therapy Need

• Identifies the total number of therapy visits (PT, OT, ST) planned for the MCR payment episode for which this assessment will determine the case mix group

• Therapy visits must relate directly and specifically to a treatment regimen established by the physician through consultation with the therapist(s)

• And be reasonable and necessary to the treatment of pt’s illness or injury


• When the pt assessment and the care plan are complete, review the plan to determine whether therapy services are ordered by the MD

• If therapy services are ordered, how many total visits are indicated over the 60 day payment episode

• If number of visits uncertain, provide your best estimate

• Collaborate with rehab services to determine their plan and the MD orders for services after rehab evals completed

• An estimate of the projected therapy visits based on the need identified and supported by comprehensive assessment is acceptable

Estimate as close as possible!

• NOTE: the final claim will be paid based on the actual number of therapy visits made to the patient. When the actual number does not match the projected number at SOC or ROC, the computers at the RHHI, will automatically adjust the predicted number up or down and there is no action required by the agency to correct M0826 on the original document

M0830: Emergent Care

• Identifies whether the patient received an unscheduled visit to any (emergent) medical services other than home care agency services

• Emergent care services include all unscheduled visits occurring within 24 hours of the time the patient has contacted the medical services


• If pt went to ER, was “held” at the hospital for observation, then released, the pt did receive emergent care

• “Holds” can be longer than 23 hours but emergent care should be reported regardless of the length of the observation “hold”

• Needs to be verified that pt was not admitted; if was admitted then transfer needs to be done

• This item includes the entire period since the last time OASIS data was collected.

• A pt who goes to ER and is then admitted should be noted as having emergent care

• A pt who dies in the ER is considered to be under the care of the ER not the home health agency, therefore, transfer is completed, not “death at home” assessment

M0840: Emergent Care Reason

• Identifies reasons for which the pt/family sought emergent care

• Mark all appropriate answers• Ask pt/cg all symptoms and reasons which

they sought emergent care• May need to call MD or ER to clarify reasons

M0855: Which Inpatient Facility…

• Identifies the type of inpatient facility to which the patient was admitted

Reason-Specific Instructions

• Admission to a freestanding rehab hospital or a rehab distinct part unit of a general acute care hospital is considered a rehab facility admit

• Admission to a SNF, an intermediate care facility for the mentally retarded or a nursing facility is a nursing home admit


• Family or medical service provider usually informs the agency that the pt has been admitted to an inpatient facility

M0870: Discharge Disposition

• Identifies where the pt resides after DC from the home health agency

M0880: After DC…

• Identifies services or assist a pt received after DC from home health agency

• M0380 lists services or assistance that can be used as a reference

M0890: Admitted…Why?

• Identifies the urgency of hospital admit• Interview pt, family or health care provider to

determine whether emergent, urgent or elective

M0895: Reasons…hospital

• Identifies the specific condition(s) necessitating hospitalization

M0900: Reasons…nursing home

• Identifies reason(s) patient was admitted to a nursing home

• Often agency clinician will have assessed conditions for which nursing home placement is necessary or appropriate

M0903: Date of Last Home Visit

• Identifies the last or most recent home visit of any agency provider, including skilled providers or home health aides

M0906: Discharge/Transfer/Death Date

• Identifies the actual date of DC, transfer or death

Documents

Outcome And ASsessment Information Set Gina Croft,MPT April 27, 2009