A Lisa Selman-Holman blog
Question: I recently attended your conference you advised us about procedure coding–that it was no longer necessary to report them as CMS does not count that. Did I understand this correctly??
Lisa says: Procedure coding is no longer required as of 4/20/2011. M1012 must still be answered but you may answer NA or UK on everyone if you’d like. There is also no requirement for surgical procedures on the POC.
The OASIS-C instrument has not expired even though the form contains a July 31, 2012, expiration date. The renewal for the OASIS-C instrument is currently at the Office of Management and Budget. An OASIS-C with a new expiration date will be released once cleared through the renewal process.
We expect M1012 (Procedures) to be deleted as well as changes to the coding data items to allow for ICD-10-CM codes. It is puzzling how CMS intends to re-word the M1020/M1022 item when the codes are no longer V and E codes. Perhaps they will delay that change like they delayed ICD-10!
Want to learn more about OASIS-C? Come to my classes!
Sept 26-27 Oregon Association for Home Care Salem, OR
October 4-5 Home Care Association of Colorado Denver, CO
November 7-8 Ohio Council for Home Care and Hospice Columbus, OH
A new set of OASIS Q&As has been posted through the OCCB website.
M1020, M1022, M1024 do not get any mention, but there are several clarifications regarding wounds, and M1012 gets a nod, as well. Below are some highlights, and the link to the full set of Q&As.
M1012
Question 3: For M1012, Inpatient Procedure, can the same relevant procedure be listed twice if the procedure was done on two different dates in the inpatient facility?
Answer 3: Currently, there would be no reason or benefit to listing a procedure more than once.
M1306
Question 8: If you have two Stage IV pressure ulcers with intact skin in-between them and a tunnel that connects them underneath the wound surface, do you have one pressure ulcer or two?
Answer 8: If a patient develops two pressure ulcers that are separated by intact skin but have a tunnel which connects the two, they remain two pressure ulcers.
M1342
Question 9: When sutures are removed from surgical wounds healing by primary intention, how does it affect the healing status of the wound?
Answer 9: For the purposes of scoring the OASIS item, M1342, Status of the Most Problematic (Observable) Surgical Wound, openings in the skin, adjacent to the incision line, caused by the removal of a staple or suture, are not to be considered part of the surgical wound when determining the status of the surgical wound. The status of these sites would be included in the comprehensive assessment clinical documentation.
When determining the healing status of the incision, follow the WOCN Guidance on OASIS-C Integumentary Items, in addition to other relevant current CMS Q&As. The status of “not healing” would only be selected if the wound, excluding the status of the staple/suture site(s), meets the WOCN descriptors.
Other topics in the Q&As:
Are rehabilitation facilities considered inpatient settings? That is the key to answering M1010, M1012 and M1016 correctly if you patient comes from such a facility.
Let’s say a patient is discharged from a hospital on Sept. 1 and goes to a rehab facility and isn’t discharged from their until Sept 24. SOC is Sept. 25.
How should M1010 (inpatient diagnosis), M1012 (inpatient procedures) and M1016 (regimen change) be answered?
The key is to remember that a rehab facility is an inpatient facility (see M1000), so the diagnoses treated there would pertain to M1010 and M1016. Procedures would not be performed at a rehab facility, so M1012 wouldn’t apply.
We’re still feeling our way around M1012, and CMS has given some guidance on relevant inpatient procedures. In its July Q&As, CMS addressed it in this way
Question: If a patient’s inpatient diagnosis was a Hemorrhagic Bleed, should the CT Scan of Brain be considered a procedure relevant to the home health plan of care and be reported in M1012 – Inpatient Procedures?
CMS answer: A diagnostic procedure that confirmed a diagnosis that is addressed in the home health plan of care is relevant and would be reported in M1012 – Inpatient Procedures. Assessing clinicians need to use their judgment in determining if a procedure is relevant to the home health plan of care.
I’ll have some thoughts on these answers later, but just wanted everyone to know that CMS has released its quarterly Q&As to clarify OASIS issues.
Here are some highlights:
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Sometimes we need to think through some of the tasks we do over and over … what do they mean? This OASIS and coding quiz gives you a chance to think and solve a puzzle!
