Coding Corner
Welcome to Coding Corner, your go-to destination for home health coding and OASIS review tips! In this training series, we will delve into the intricacies of coding in the home health setting, providing you with expert insights and practical guidance to enhance your skills and proficiency. Whether you are a seasoned professional looking to sharpen your knowledge or a newcomer eager to learn the ropes, Coding Corner is designed to empower you with the tools and techniques necessary to excel in this specialized field. Get ready to unlock the secrets of accurate coding and OASIS review, as we embark on this enriching journey together. Let’s dive into the world of home health coding and elevate your expertise with Coding Corner!
What is the OASIS Walk and How is it Used in Home Health?
Clinicians in home health use the OASIS Walk to gather information efficiently during assessments. During this walk, clinicians ask the patient to demonstrate various activities to assess their abilities. Some key aspects clinicians inquire about during the OASIS Walk include:
- Gait patterns and the patient's ability to ambulate and transfer independently.
- Level of pain as the patient rises from and lowers to a chair.
- Ability to dress the lower body.
- Health literacy by asking the patient to read a medication label.
- Ability to prepare food independently, perform household chores, comply with diet, and recall dietary information.
- Safety hazards in the home like throw rugs, clutter, or absence of smoke detectors.
- Possible incontinence issues if soiled clothing is observed.
By observing these aspects during the OASIS Walk, clinicians can efficiently gather crucial information for accurate assessments and care planning.
Understanding OASIS Item M1845: Toileting Hygiene and Safety
OASIS Item M1845 is a crucial assessment point that frequently appears in the top 10 assessments. This item is closely related to toileting hygiene and often goes hand in hand with lower body dressing (M1820).
- It involves considering the logistics of toileting, such as pants removal, personal hygiene, and assistance needs.
- Patients' ability to perform toileting tasks independently without pain or shortness of breath determines the level of assistance required. Some may need minimal support like hygiene setups or wipes, while others may be completely dependent on assistance for toileting activities.
- Clinicians sometimes misinterpret responses, marking patients as completely dependent when they may require varying levels of assistance. It's essential to understand the scale from complete dependence (response 3) to no help needed (response 0) accurately.
In home health settings, clinicians should encourage patients to perform tasks like walking to the bathroom with minimal assistance to assess their functional abilities accurately. Observation plays a vital role in evaluating patients’ actual capabilities beyond what they claim they can do.
Educating clinicians on the importance of safety in toileting tasks is crucial. Ensuring patients can perform these activities safely is so important in OASIS assessments, emphasizing the significance of accurate observation and assessment for overall patient well-being.
COPD Documentation and Patient Safety: What to Look for in Home Health Care
In this video, we delve into the essential aspects of documenting COPD (Chronic Obstructive Pulmonary Disease) and ensuring patient safety in home health care settings. When assessing a patient with COPD, clinicians need to pay attention to various key points within the documentation.
We explore the significance of identifying exacerbations in COPD patients, which may lead to treatments like steroids and antibiotics. Assessing if the patient requires oxygen and ensuring its safe use at home is crucial for patient well-being. Additionally, evaluating respiratory failure levels and monitoring for smoking risks with oxygen use are vital considerations.
The video emphasizes the importance of accurately documenting shortness of breath levels (M1400) and assessing the patient’s functional impairment related to COPD. Educating patients on medication adherence, proper inhaler use, and oxygen safety is essential for managing COPD effectively and preventing exacerbations that could result in hospitalizations.
By highlighting the importance of thorough documentation, education, and monitoring in home health care, clinicians can help patients with COPD maintain their independence, safety, and overall well-being while reducing the risk of exacerbations and hospitalizations. Stay tuned for valuable insights on optimizing care for COPD patients in home health settings.
Mastering OASIS Item M1850: Key Insights and Best Practices for Clinicians
Join Tina and Steph in this insightful discussion as they delve into the nuances of OASIS Item M1850. Discover why over 30% of OASIS changes stem from this crucial item and learn how to accurately assess and document patient needs. Uncover common misconceptions, such as the importance of considering both human assistance and assistive devices for accurate scoring.
Explore the significance of patient safety and ability in transferring safely, efficiently, and effectively. Gain valuable tips on avoiding common pitfalls in scoring, understanding the role of physical therapy assessments, and supporting referrals for therapy services based on M items. Enhance your understanding of the assessment process to ensure patients receive the appropriate care they need to thrive at home.
Don’t miss out on this informative video that will empower clinicians to make informed decisions when responding to OASIS Item M1850 and improve patient outcomes through accurate documentation and care planning.
Mastering M1033: Optimal Home Health Assessment and Reimbursement
Unlock the key insights behind the significance of M1033 in home health. This session delves into the critical impact of M1033 on PDGM and STAR ratings, as well as influencing reimbursement levels. Learn how accurately addressing this item can earn up to 11 points for responses to questions one through seven.
Explore its relevance within the PDGM model, contributing to a patient’s overall risk for hospitalization. Leaders in home health will discover strategies to create a comprehensive patient profile, ensuring maximum reimbursement for the care provided.
The session delves into specific areas, such as the history of falls, emphasizing the inclusion of various injuries beyond fractures. Unintentional weight loss criteria are clarified, emphasizing the importance of BMI inclusion. Multiple hospitalizations are discussed in detail, focusing on the timeframe and admission criteria.
Gain insights into identifying and addressing declines in mental, emotional, or behavioral status within the last three months. The session also covers reported difficulties in complying with medical instructions, providing clarity on compliance and documentation requirements.
The importance of assessing medication usage is emphasized, clarifying that it includes prescribed and over-the-counter medications, vitamins, injectables, and the consideration of prescribed quantities. The session addresses patient-reported exhaustion, highlighting its impact on overall engagement in healthcare activities.
Throughout the session, emphasis is placed on educating field staff to enhance patient assessment skills and clinical judgment, ultimately aiding in accurate item capture. Participants are encouraged to review M1033 regularly due to its significance and the functional points it offers.
Decoding CHF: Navigating Complex Coding Scenarios in Heart Failure
Welcome to Coding Corner! In this episode, we delve into a detailed scenario involving CHF (Congestive Heart Failure) and the coding process. Mrs. Jones presented with concerning symptoms such as increased shortness of breath, significant leg swelling, fatigue, and difficulty ambulating, leading to her hospitalization with a diagnosis of decompensated diastolic heart failure.
Our expert coders, Tina and Stephanie, navigate through the complexities of coding this scenario. They emphasize the importance of sequencing codes correctly based on guidance. Hypertension is coded prior to CHF due to their assumed relationship, with the code I11.0 for hypertensive heart disease with CHF.
The concept of acute on chronic conditions is highlighted when coding acute exacerbation of diastolic heart failure as I50.33. The history of systolic heart failure is captured as I50.22 to distinguish between the two types of heart failure in this case.
End stage heart failure (I50.84) and permanent AFib (I48.21) are also meticulously coded in accordance with guidelines, ensuring accurate representation of Mrs. Jones’ complex medical history.
Join us as we unravel the intricacies of medical coding and learn how to accurately document and code complex patient scenarios like Mrs. Jones’. Stay tuned for more insightful discussions on Coding Corner!
Understanding Pathological Fractures and Coding Guidelines in Medical Records
We delve into the crucial aspect of coding fractures accurately by understanding the underlying cause of a fracture. Join us as we explore a case where what may seem like a traumatic fracture due to a fall actually reveals itself as a pathological fracture caused by osteoporosis. Learn why identifying osteoporosis in documentation is pivotal in coding such fractures correctly.
Discover the distinction between trauma fractures and osteoporosis fractures, and how the presence of osteoporosis changes the coding approach. Gain insights into differentiating between various types of fractures based on their etiology and how to interpret medication profiles for clues about underlying conditions like osteoporosis.
Follow along as we discuss the importance of thorough documentation review, recognizing key indicators like osteoporosis mentions, and adjusting coding practices accordingly. Find out why coding fractures with active treatment in hospitals differs from post-treatment at home, and how to prioritize the primary diagnosis while incorporating relevant codes for procedures like hip replacements.
M2020 Management of Oral Medications
- What to do if all discharge medications are not present at the start/resumption of care
- How M2020 ties into the ambulation item M1860
- Assessing the patient's abilities before any interventions are implemented
- Ensuring accurate coding for quality care and maximum PDGM reimbursement
Specifics of Coding Dementia
In this episode of Coding Corner, we dive deep into the intricacies of coding dementia. Our experts, Tina and Stephanie, provide a thorough understanding of this complex condition and its various manifestations.
We begin by defining dementia and its characteristic symptoms, including memory loss, cognitive impairment, language problems, disorientation, and changes in mood and behavior. As the condition progresses, more severe symptoms like hallucinations, delusions, aggression, and wandering may occur.
Key Takeaways:
- Identifying the underlying condition or disease process (e.g., Alzheimer's, Parkinson's, stroke) is crucial for accurate coding.
- Understand the varying levels of dementia: mild, moderate, and severe.
- Code dementia to the highest specificity, considering factors like behavior disturbances, agitation, psychotic disturbances, mood disturbances, and anxiety.
- Learn about coding specific disturbances, including agitation, sleep disorders, anxiety disorders, mood disorders, and psychotic disturbances.
- Remember to use additional codes when necessary to further describe the condition.
Join us for expert guidance on navigating the complexities of coding dementia, ensuring accurate and compliant coding practices.
Don’t miss this informative episode, packed with valuable insights and practical tips for coding professionals.
N0415 Coding High Risk Medications
This episode provides a comprehensive overview of the Oasis item N0415, which focuses on high-risk medication classification in home health care. Learn about these 6 high-risk drug classes that pose potential side effects and risks, especially in the elderly, including:
- Opioids (e.g., Tramadol, Oxycontin, hydrocodone)
- Antiplatelets (e.g., aspirin, Plavix)
- Hypoglycemics (oral and insulin)
- Antipsychotics (e.g., quetiapine, haldol, risperidol)
- Anticoagulants
- Antibiotics (e.g., doxycycline, penicillin, azithromycin)
- Ensures patient safety
- Helps prevent emergency room visits and hospitalizations
- Allows for patient and caregiver education
Key Points for Clinicians:
- Include all high-risk medications, regardless of administration route or setting
- Code medications based on therapeutic category/classification, not just indication
- Document indications for all medications within the same drug class
- Include newly prescribed medications, even if not yet taken
- Consider PRN (as-needed) medications
Patient Education
- Provide detailed information about each medication
- Discuss potential side effects and adverse reactions
- Teach recognition of warning signs
- Develop an action plan for responding to side effects
This episode emphasizes the importance of thorough assessment and documentation of high-risk medications in home health care, highlighting the role of clinicians in ensuring patient safety and providing comprehensive education.
OASIS E1 Changes
This episode covers the new item being added to OASIS E1 in 2025 as well as the items being removed. There are Minimal Updates for OASIS E1 in 2025 as OASIS E was such a tremendous update in 2023
New Item Added
O0350: New item assessing if the patient’s COVID-19 vaccination is up to date
- This item will be used to collect data regarding the patient’s COVID-19 vaccination status at specific timepoints: Transfer, Death at Home, and Discharge. Clinicians will code this item using two options:
- 0 = No, patient is not up to date
- 1 = Yes, patient is up to date
Removal of the following:
M0110 – Episode Timing. Removing this item streamlines OASIS documentation, reducing redundancy in data collection.
M2200 – Therapy Need. The item related to therapy visits will be removed, as it is no longer tied to payment adjustments under the Patient-Driven Groupings Model (PDGM).
Discharge Goals column for GG0130 (Self-Care) and GG0170 (Mobility) will be removed from SOC/ROC assessments and replaced with a discharge function score.
Mandatory OASIS Reporting for ALL Payors
Starting January 1, 2025, Certified Home Health Agencies (CHHAs) will begin completing and transmitting OASIS data for 100% of patients, not just those with Medicare, Medicare Advantage, or skilled Medicaid.
- All payers will be included in outcome calculations starting July 1, 2025, Transitional time frame from January 1, 2025 – June 30, 2025 – Agencies may voluntarily submit OASIS for non-Medicare patients. However, beginning July 1, 2025, submission becomes mandatory. Home health agencies must complete and transmit OASIS assessments for ALL of their patients, regardless of payer type.
- This will align home health agencies with skilled nursing facilities that already report patient data for all payor types and allows for fair comparisons between home health agencies and skilled nursing facilities.
- Provides a more accurate and fair comparison across the post-acute care continuum.
Consider partnering with a reputable OASIS review outsourcing company such as HRP!
This new reporting requirement isn’t merely about compliance—it’s an opportunity for agencies to flourish. Agencies that take proactive measures to improve their processes and results will be better positioned for future success.
The discharge function score will be calculated based on the scoring of the GG items which will drive agency outcomes and star ratings.
What Should Agencies Do to Prepare?
- Provide comprehensive OASIS training to all clinical staff.
- Educate field staff on the new requirement and provide training to improve documentation accuracy.
- Be sure each clinician is completing a thorough and accurate OASIS assessment for every patient, regardless of their insurance coverage or payor source.
- Focus on improving outcomes that drive quality measures and optimize PDGM case mix weight.
- Begin voluntary OASIS reporting for non-Medicare patients during the transitional period, instead of waiting for July 1st.
GG Items and Discharge Function Scoring
It is important to understand that the GG items and Discharge Function Scoring must be accurately calculated as this will have a significant impact on Value Based Purchasing.
Agencies are Incentivized through VBP for the reimbursement of each patient. Reimbursement will be affected by a 5% increase or decrease in payment.
Some of the GOALS of VBP:
- Reduce Hospitalization and use of Emergency Department
- Reduce Spending
- Increase Patient Mobility
- Offer a more positive experience with Home-health
The old measure of OUTCOMES will be replaced with a new Discharge Function Score. This score will be between 10-60.
Previously, OUTCOMES were based on the M1800s (ADLs), M1400 (dyspnea), M2020 (oral med mgmt.), and M2420 (Discharge disposition).
This score will now be based on:
M1400 (dyspnea), M2020 (oral med mgmt.) AND:
Mobility GG Items include Rolling, Lying, Transfer ability, and Ambulation.
Functional GG Items – Eating, Oral Hygiene, and Toileting Hygiene.
Keep in mind, dressing and grooming are no longer included.
The score will now be a sum between 10 and 60.
GG ITEM RESPONSE ITEMS
06 Independent – No assist needed at all
05 Set-up or clean-up assistance – No help needed during task completion
04 Supervision/Touching assistance – Verbal cueing, touching/steadying assistance, or supervision. Help may be throughout or intermittent.
03 Partial/Moderate assistance – Helper completes less than 50% of the effort
02 Substantial/Maximum assistance – Helper completes more than 50% of the effort
01 Dependent – when two helpers are needed, that equals DEPENDENT.
ANA (Activity not Attempted) IF USED in calculation, CMS will impute this data (best estimate of what the answer should be). Don’t give CMS the control, keep it with you!
07 Patient Refused – should not be used/rarely –needs additional documentation
09 Not Applicable “09 is baseline” No attempt during or prior to the assessment
10 Not attempted due to environmental limitations, ex. Lack of equipment and weather constraints
88 Not attempted due to medical condition or safety concern (current status but should be improved at D/C) “88 is current state” due to patient’s current medical condition.
