CMS clarified several months ago that toenail removal by a physician is an excision, not a surgical wound. Please answer M1340 accordingly.
December 30, 2011
Gait impairment may impact M1850
CMS has provided some guidance on gait impairment and its potential impact on M1850 …
Question: When completing M1850, Transferring, do I consider the patient’s gait impairment if they must ambulate 12 feet from the bed to get to the closest sitting surface and the need for assistance of another person?
CMS Answer: The need for assistance with gait may impact the M1850, Transferring score if the closest sitting service applicable to the patient’s environment is not next to the bed. M1850 reports the patient’s ability to move from the supine position in bed (or the routine sleeping surface) to a sitting position at the bedside, then some type of standing, stand-pivot, or sliding board transfer to a sitting surface at the bedside. If there is no chair at the bedside, report the ability to transfer from the sleeping surface to whatever sitting surface is applicable to the patient’s environment and need.
If the sleeping surface is in the bedroom and the sitting surface is down the hall in the bathroom and the patient is independent moving from the supine to sitting position, sitting to standing, and then standing to sitting, but requires minimal human assistance or an assistive device to ambulate from the bed to the sitting surface, the appropriate M1850 score would be a “1″. If the patient requires more than minimal assistance or requires both minimal human assistance and an assistive device, the appropriate score would be a “2”.
December 9, 2011
When would you answer M1730 with NA?
This is part of a recent clarification from CMS on M1730, depression screening.
I don’t understand when I would ever select “NA – Unable to respond” in the PHQ- 2 in M1730, Depression Screening. Please clarify.
CMS Answer: The PHQ-2 is only used for patients that appear to be cognitively and physically able to answer the two included questions. After determining the PHQ-2 is an appropriate tool, the patient may decline or be unable to answer the questions, e.g. patient states the questions are too personal, or the patient may not be able to quantify how many days they have experienced the problems.
November 23, 2011
M1308, the question that keeps on giving …
Several questions in CMS’s 3rd quarter Q&As deal with pressure ulcers and M1308.
The highlights (in my words, not CMS’s!):
- Should a muscle flap be reported in M1308 as a current pressure ulcer? No. It is a surgical wound (as are skin advancement flap, or rotational flap)
- If the pressure ulcer has a skin graft, how is it treated? Not as a surgical wound but as unstageable until it heals, then Stage III or IV.
- How do you report a Stage III that is closing to the point of a pinpoint? As a Stage III …
October 27, 2011
M1350 is ‘no’ if there is no intervention at discharge
Question:We have a patient who was admitted to home care for dressing changes to a traumatic open wound. The wound healed and the patient was discharged. For M1350 on discharge, since the wound is healed, should the question be answered “No” because the wound is healed and no longer needs any intervention or “Yes” because up to the time of DC, she did require interventions?
Lisa says: Answer yes only if the wound required intervention at discharge even if intervention was not done. If the wound didn’t require intervention at discharge , answer no.
October 25, 2011
Answers to when we have to report admissions
Too often we learn about transfers of our patients after the fact. CMS released its 3rd quarter Q&As recently and addressed the item, including the turnaround time when we have to report the transfer.
M0100
Question 1: A patient is seen monthly. On a monthly visit, which falls within the last five days of the certification period, the assessing clinician discovers the patient had a qualifying hospital admission since the last monthly visit that our agency was not aware of. Do we complete a Transfer, Resumption and Recert or just the Transfer and Resumption?
Answer 1: When the agency learns of a qualifying Transfer after the patient returned home, a Transfer and Resumption is required within 2 calendar days after learning of the inpatient stay. In this situation, a Transfer is required; and, since the time frame to complete the Resumption overlaps with the timeframe to complete the Recertification, the ROC assessment should be completed, fulfilling both the ROC and Recert requirements.
May 16, 2011
The first visit to the home is the ROC
Some agencies are under the impression that the first visit after the patient returns from an inpatient facility stay has to be the ROC assessment and they believe that any visit prior to the ROC assessment cannot be billed. Both are misunderstandings. The first visit by anyone by your agency, billable or non-billable, is the ROC visit and so the date of that visit is placed in M0032. The ROC assessment has to be completed within 48 hours of return home.
Here is the information from OASIS Q&As
[Q&A ADDED & EDITED 9/09; Previously CMS OCCB 01/09 Q&A #5]
Q15.1. My patient was released from the hospital and needed an injection that evening. The case manager was unavailable and planned to resume care the following day. Could the on call nurse visit and give the injection before the resumption of care assessment is done? Is there a time frame in which care (by an LPN or others) can be provided prior to the completion of the ROC assessment?
A15.1. There are no federal regulatory requirements that prevent an LPN from making the first visit to the patient when resuming care after an inpatient facility stay, but there must be physician orders for the services/treatments provided during that visit. It is not required that the ROC comprehensive assessment be completed on the first visit following the patient’s return home. OASIS guidance states that the Resumption of Care comprehensive assessment must be completed within 2 calendar days after the patient’s return from the inpatient facility. The clinician that completes the ROC comprehensive assessment must be an RN, PT, OT or SLP.
In the case of an unknown hospitalization, a LPN/LVN, aide, or PTA etc makes a regularly scheduled visit and finds that the patient has had a hospitalization meeting the criteria for transfer, calls the agency and reports the hospitalization. The orders you have for the episode are still valid orders after an inpatient admission, so if that regularly scheduled visit has orders that visit is still billable. That visit date is also the date placed in M0032. The qualified clinician has 2 days from the point of acquiring the knowledge of the hospitalization to complete the transfer and the ROC assessments. M0090 is the date the assessment was actually completed.
April 26, 2011
Major improvement or decline require a follow-up assessment
Question: Let’s say that I did a recert on 4/11/2011 and then the patient had an outpatient mastectomy 4/12/2011. I went to see her on 4/13/2011, which was the first day of her recert. Would this visit be considered a SCIC or can we do as a regular visit and a telephone order for the orders of the mastectomy care?
Lisa says: A follow-up assessment is required for a major improvement or decline in condition, but your policy defines major improvement or decline. You must complete another follow-up assessment if the circumstances meet your policy.
April 5, 2011
Episode dictates restart of therapy counts
Question: Does the therapy count start over if a patient is admitted to the hospital? Since new therapy evaluations are completed after the post-hospital visit (resumption of care), would a new count begin at this point?
Lisa says:This has to do with the number of therapy visits per episode. The count does not start over after a hospitalization unless you’re in a new episode.
March 23, 2011
HHQI data reports are now available
The January 2011 HHQI reports for ACH and Oral Medications are now available online These reports provide a look into the potential causative factors of ACH rates and also focus on M2020.
The reports are available in PDF, CSV, XML, MHTML, Excel, TIFF, and Word.
Here is how to get to the data:
1. Go to the HHQI Web site, www.homehealthquality.org
2. Click on the Quick Link (right side) for “HHQI Data Access System.” This will lead you to a secure website.
3. Log in with your username and password.
3. Log in with your username and password.
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