Posts tagged ‘m2250’

October 12, 2012

Does N/A in one place mean N/A in all?

Question: If a M2250 question is answered N/A on the SOC or ROC, would M2400 on the transfer or DCO automatically be N/A as well?

For example:  M2250 (E) pain was answered N/A on the SOC because no pain was identified. Then sometime during the episode the patient fell and now has pain in the Rt knee r/t the fall. The patient is placed on a pain medication for the acute pain. The nurse identifies the need for pain interventions to monitor and mitigate the pain.  The nurse uses a standardized pain assessment tool to rate the pain, writes a verbal order to add pain interventions to the POC, and implements the interventions.  At the discharge OASIS, would M2400 (D) be answered N/A because no other OASIS was performed since the SOC and on the SOC the POC synopsis (E) was N/A OR since the nurse addressed the pain by assessing the patient’s pain with the standardized tool, wrote the VO to include the interventions in the POC and implemented them, could she answer #1 on M2400 ?

Lisa says: Intermittent verbal orders count as well, so if you get an order for assessment and intervention sometime in the episode and the interventions are completed as you described in your scenario, then the answer is ‘yes’ on the discharge.

Formal assessment does mean the standardized and/or validated tools contained in those specific M items you mentioned. The trick is that if the last assessment done was the recert, those M items are not part of the recert. However, N/A cannot apply if no formal assessments were done, so when discharging and the last OASIS was a recert the answer has to be either yes or no.

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August 23, 2010

M1240 … a pain to get right?

Pain is such a subjective subject, and I’ve heard from many clinicians who wonder how to answer M1240 correctly … does it refer only to severe pain? When does pain qualify? So let’s look at the question, then at ways to assess.

M1240: Has the patient had a formal pain assessment using a standardized pain assessment tool (appropriate to the patient’s ability to communicate the severity of pain)?
0: No standardized assessment conducted
1: Yes, and it does not indicate severe pain
2: Yes, and it indicates severe pain

The OASIS Guidance Manual tells us that this item’s intent is to see if a standardized assessment was conducted, and what the level of pain was, if, and only if, the assessment was conducted.

The item’s intent deals with the assessment, and CMS has stated that clinicians should assess for “any and all pain the patient experiences.” (April 2010)

When dealing with M1240, watch M2250 (Plan of Care Synopsis) and M2400 (Intervention Synopsis).

M2250 is where it would be noted if the doctor ordered interventions and monitoring for the pain. Only mark NA if the patient is not experiencing pain. (That’s NO PAIN AT ALL.)

August 13, 2010

M0090, M1350, and M2004 questions answered

Here are answers to three recent questions that I have fielded on OASIS:

For M0090, we’ve heard that is the date that we  (RNs) complete the OASIS assessment, including getting frequency from PT, OT, ST, and response from MD if any abnormalities with meds are found … this occurs all in a five-day window. Others are teaching to put the M0o90 date as the date we (RNs) complete the assessments without info from others. How do we fill this item?

Lisa says: The assessing clinician has six days to complete the SOC assessment.  (Assessment is day zero + five days.) This time period includes collaboration with other clinicians, i.e., M2200, and waiting for the physician’s response for M2250. M0090 is the date the assessment is completed, and it is not complete until that info has been received.

If you address a wound under Wound 1 in M1350, do you answer as a ‘yes’? Or does this question only apply to the previous questions about ulcers. If you have a PICC line that you address later in the SOC, do you answer M1350 as ‘yes’?

Lisa says: M1350 includes any wounds or skin lesions OTHER than the pressure ulcers, stasis ulcers, surgical wounds already addressed, and bowel ostomies, which are also addressed in another item. The answer ‘yes’ on M1350 means that the skin lesion or wound requires intervention and assessment. PICC lines that require intervention ARE included.

Let’s say that the SOC and DC OASIS are all that were completed when answering M2004. You answered it as ‘no’ on the SOC because you did not receive a response from the MD in 24 hours, you have addressed all issues, and no new issues have appeared. Do you answer this as ‘NA’ or ‘no’ if the MD did not respond in the 24 hours from the SOC OASIS?
Lisa says: If the physician does not respond within one calendar day (which can be longer than 24 hours, given the way CMS has defined it) the answer has to be ‘no’ on M2004. If there were no issues identified, then ‘NA’ would be the correct answer. Keep alert to news on this, as some recent CMS guidance could muddy this answer.

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July 13, 2010

10 days for comprehensive assessment? 5? 6?

I didn’t realize that the language in the OASIS Guidance Manual and the Conditions of Participation are slightly different, and that has caused some confusion with HHAs.

The Guidance Manual states that “At the start of care time point, the comprehensive assessment should be completed within five days of the start of care date”.

Conditions of Participation (484.55(b)) states that the assessment must be complete “no later than five calendar days after the start of care.”

Do you have 10 days … five days before and five after the SOC (using “within” to mean that in the OASIS manual?) Or five days … five calendar days, according to the CoP?

CMS has clarified that SOC is day zero, so you have six days to complete the assessment.

Here are a couple of examples where knowing this is useful and can keep you in compliance:

M2250 requires that the agency communicate findings to the physician and get orders for the best practices applicable, e.g., physician-ordered patient specific parameters, assessment and diabetic foot care. The agency has the 6 days to get the assessment done and get verbal orders back from the physician before you have to check ‘yes.’

M2010 requires that education be provided at SOC on high risk meds. You have those six days to complete teaching.

M0090 can be a day other than the day of initial visit … it can take more than one visit to complete the assessment.  Consider this example: You have a therapy-only case, and therapy does the initial eval on July 9; that’s the SOC. Therapy won’t do the OASIS, so nursing will come Monday the 11th.

The OASIS has to have a M0090 date of no later than the 14th. The therapist may do a falls risk assessment, but that doesn’t count toward the best practice. The falls risk assessment has to be completed by the assessing clinician within the timeframe of the SOC.

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