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PP for HHA providers

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Jan. 28, 2023

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OutcomeandAssessment
InformationSet(OASIS)- E
December 2022
HaidehNajafi,BSN,RN,MSED,EDS
RAI/MDSandOASISEducationalCoordin...

ImportantNotice
 This training is current as of the date of this presentation.
 Information in this training is not inte...

Objective
 Describe the Standardized of the assessments in the PostAcute
Care (PAC) setting.
 Describe current use of OA...

The current uses for OASIS include:
1) Home HealthAgency Medicare-Certification Surveys.
2) The quality measures on the c...

5) The QualityAssessment Only (QAO) Metric used in home
health pay-for- reporting (P4R).
6) The OASIS instrument also play...

 Regulatory language stipulates that the encoded OASIS
data must accurately reflect the patient’s status at the
time the ...

 Processes to promote data accuracy may include:
– Clinical record audits.
– Data entry audits.
– Reports produced from e...

ImprovingMedicarePost-AcuteCare
TransformationACT(IMPACTACT)
 The Improving Medicare Post-Acute Care
TransformationAct (I...

StandardizingFunctionattheItemLevel
9
InpatientRehabilitation
Facilities
PatientAssessment
Instrument
(IRF-PAI)
IRF-PAI
Lo...

ImprovingMedicarePost-AcuteCare
TransformationACT(IMPACTACT)
 The collection of data in a standardized manner facilitate:...

Implementationof theOASIS-E
 These changes will become effective on January 1st,
2023, with OASIS-E.
11

Developan ImplementationStrategy
12
Reviewthe
finalizedOASIS-E
guidance.
Revisepoliciesandprovideeducation
andtrainingtoen...

Changes fromOASIS-D toOASIS-E
 OASIS-E reflects revisions based on proposals finalized
in the:
– CalendarYear (CY) 2019 H...

Changes fromOASIS-D to OASIS-E
 Main reason to revise the OASIS is:
– To increase standardization across post-acute (PAC)...

Changes fromOASIS-D toOASIS-E
 With OASIS-E, effective January 1, 2023, the items that were
made optional with OASIS-D1 w...

NochangesontheseOASISitems
17
SectionA.AdministrativeInformation:PatientTracking
OASIS-E Item # OASIS-D Item # Item Descri...

NochangesontheseOASISitems
18
SectionA.AdministrativeInformation:PatientTracking
OASIS-E Item # OASIS-D Item # Item Descri...

NochangesontheseOASISitems
19
SectionA.AdministrativeInformation
OASIS-E Item # OASIS-D Item # Item Description
M0080 M008...

NochangesontheseOASISitems
20
SectionC.CognitivePatterns
OASIS-E Item # OASIS-D Item # Item Description
M1700 M1700 Cognit...

NochangesontheseOASISitems
21
SectionF.PreferencesforCustomaryRoutine
OASIS-E Item # OASIS-D Item # Item Description
M1100...

Nochanges on theseOASISitems
22
SectionG.FunctionalStatus
OASIS-E Item # OASIS-D Item # Item Description
M1810 M1810 Curre...

NochangesontheseOASISitems
23
OASIS-E Item # OASIS-D Item # Item Description
M1600 M1600
Hasthispatientbeentreatedfora
Uri...

Nochanges on theseOASISitems
24
OASIS-E Item # OASIS-D Item # Item Description
J1900 J1900 NumberofFalls
SectionJ.HealthCo...

Nochanges on theseOASISitems
25
OASIS-E Item # OASIS-D Item # Item Description
M1060 M1060 HeightandWeight
SectionK.Swallo...

NochangesontheseOASISitems
26
OASIS-E Item # OASIS-D Item # Item Description
M2003 M2003 MedicationFollow-up
M2010 M2010
P...

Nochanges on theseOASISitems
27
OASIS-E Item # OASIS-D Item # Item Description
M1046 M1046 InfluenzaVaccineReceived
Sectio...

OASISItemsremoved
29
OASIS-D Item # Item Description
Item/InstructionChange
Description
M0140 Race/Ethnicity Removed
Secti...

OASISItemsremoved
30
OASIS-D Item # Item Description
Item/InstructionChange
Description
M1730 Depression Screening Removed...

OASIS Itemsremoved
31
OASIS-D Item # Item Description
Item/InstructionChange
Description
M1242
FrequencyofPainInterfere
wi...

OASISItemsremoved
32
OASIS-D Item # Item Description
Item/InstructionChange
Description
M2016
Patient/CaregiverDrug
Educat...

OASISItems-SkipTextRemoved/updated
OASIS-E OASIS-D ItemDescription NewItem
Item
Text
Skip
Pattern
Item/InstructionChange
D...

OASISItems-SkipTextRemoved/updated
OASIS-E
OASIS-
D Item Description NewItem
Item
Text
Skip
Pattern
Item/InstructionChange...

OASISItems-SkipTextRemoved/updated
OASIS-E
OASIS-
D
ItemDescription NewItem ItemText
Skip
Pattern
Item/InstructionChange
D...

TextEdit
OASIS-E OASIS-D Item Description NewItem ItemText
Skip
Pattern
Item/InstructionChange
Description
38
SectionA.Adm...

TextEdit
OASIS-E OASIS-D ItemDescription
New
Item
Item
Text
Skip
Pattern
Item/InstructionChangeDescription
39
SectionGG.Fu...

TextEdit
OASIS-E OASIS-D ItemDescription
New
Item
ItemText
Skip
Pattern
Item/InstructionChangeDescription
40
SectionGG.Fun...

TextEdit
OASIS-E OASIS-D ItemDescription
New
Item
Item
Text
Skip
Pattern
Item/InstructionChangeDescription
41
SectionGG.Fu...

TextEdit
OASIS-E
OASIS-
D
ItemDescription NewItem ItemText
Skip
Pattern
Item/InstructionChange
Description
42
SectionH.Bla...

NotCollectedatFU
OASIS-E
OASIS-
D
ItemDescription NewItem ItemText
Skip
Pattern
Item/InstructionChange
Description
44
Sect...

NotCollectedatFU
OASIS-E
OASIS-
D
ItemDescription
New
Item
Item
Text
Skip
Patter
n
Item/InstructionChange
Description
45
S...

NotCollectedatFU
OASIS-E OASIS-D ItemDescription NewItem ItemText
Skip
Pattern
Item/InstructionChange
Description
46
Secti...

NotCollectedatFU
OASIS-E
OASIS-
D
ItemDescription NewItem ItemText
Skip
Pattern
Item/InstructionChange
Description
47
Sect...

OASIS Items
Addto follow-up(withOASIS-D1)
48

Addto Follow-up
OASIS-E OASIS-D Item Description NewItem ItemText
Skip
Pattern
Item/InstructionChange
Description
49
Secti...

New SocialDeterminationsOf Health
(SDOH) Items
New SDOH items for HHA:
– A1005- Ethnicity
– A1010- Race
– A1100- Language...

New Non-SDOH Items
 New Non- SDOH items for HHA:
– A2120-A2124- Transfer of Health
information.
– B0200- Hearing
– B1000-...

New Items
53
SectionA.AdministrativeInformation:PatientTracking
OASIS-E ItemDescription NewItem
Item/InstructionChange
Des...

NewItems
54
SectionA.AdministrativeInformation
OASIS-E Item Description NewItem
Item/Instruction
ChangeDescription
A1110 L...

NewItems
55
SectionA.AdministrativeInformation(cont.)
OASIS-E ItemDescription NewItem
Item/Instruction
ChangeDescription
A...

NewItems
56
SectionB.Hearing,Speech,Vision
OASIS-E Item Description NewItem
Item/InstructionChange
Description
B0200 Heari...

NewItems
57
SectionC.CognitivePatterns
OASIS-E Item Description NewItem
Item/InstructionChange
Description
C0100
ShouldBri...

NewItems
58
SectionD.Mood
OASIS-E Item Description NewItem Item/InstructionChangeDescription
D0150
PatientMoodInterview(PH...

New Items
59
SectionD.Mood(cont.)
OASIS-E Item Description NewItem Item/InstructionChangeDescription
D0160 TotalSeveritySc...

NewItems
60
SectionJ.HealthConditions
OASIS-E ItemDescription
New
Item
Item/InstructionChangeDescription
J0510 Pain Effect...

NewItems
61
SectionJ.HealthConditions(cont.)
OASIS
-E
ItemDescription
New
Item
Item/InstructionChangeDescription
J0520
Pai...

NewItems
62
SectionJ.HealthConditions(cont.)
OASIS-E ItemDescription NewItem Item/InstructionChangeDescription
J0530
Pain ...

NewItems
63
SectionK.Swallowing/NutritionalStatus
OASIS-E Item Description NewItem Item/InstructionChangeDescription
Secti...

NewItems
64
OASIS-
E
ItemDescription NewItem
Item/InstructionChange
Description
SectionO.SpecialTreatments,Procedures,andP...

M2420-DischargeDisposition
 Guidance modifying the definition of “formal assistive
services” M2420 – Discharge Dispositio...

Non-PhysicianPractitioners
Guidance was updated related to allowing orders to be received from
select non-physician pract...

M0102–Dateofphysician-orderedSOC/ROC
 The date specified by a physician/allowed practitioner
order to start home care ser...

M0104 –Dateofreferral
 A valid referral is considered received when the
agency has received adequate information about a
...

M1021-Primarydiagnosis,and
M1023–Other diagnoses:
 The assessing clinician determine the primary and
other home health di...

OASIS data collection
 OASIS data are collected for:
– Skilled Medicare and Medicaid patients.
– Patients 18 years and ol...

Whoexcludedfor OASIS data
collectionandsubmission?
 OASIS data collection and submission are excluded for:
– Patients rec...

OASISandtheComprehensiveAssessment
 The comprehensive assessment including OASIS, if
applicable, completed by one clinici...

TimePoints
74
Time Point
Reason forAssessment
(RFA, M0100)
Assessment Timeframe
Start of care (SOC)
1.Start of care – furt...

TimePoints
75
Time Point
Reason forAssessment
(RFA, M0100)
Assessment Timeframe
Follow-up (FU)
4.Recertification
(follow-u...

Time Point
Reason forAssessment
(RFA, M0100)
Assessment Timeframe
Transfer to an
Inpatient Facility
(TRN)
TimePoints
76
6....

TimePoints
77
Time Point
Reason forAssessment
(RFA, M0100)
Assessment Timeframe
Discharge from
Agency – not to an
inpatien...

WhoCompletesOASIS
 M0080 (Discipline of Person CompletingAssessment) indicated
the comprehensive Start of Care (SOC) asse...

Who CompletesOASIS (cont.)
– Effective January 1, 2022, Occupational Therapist (O.T.)
may conduct the SOC comprehensive as...

WhoEstablishMedicareeligibility
 Services which establish eligibility for the Medicare
home health benefit include:
– Ski...

Who cannot CompletesOASIS
 The following staff may NOT be responsible for
completing the comprehensive assessment and OAS...

WhoCompletesOASIS
 Multidisciplinary cases may have multiple points of
discipline-specific discharge, though there is onl...

General OASIS ItemConventions
1. Understand the time period under
consideration (look back) for each item.
 Report what i...

DayofAssessment
 Day of assessment is defined as:
– The 24 hours immediately preceding the
home visit; and
– The time spe...

GeneralOASISItemConventions
2. For OASIS purposes, in order to be considered a
complete quality episode, a quality episode...

GeneralOASIS ItemConventions
3.If the patient’s ability or status varies on the day
of the assessment, report the patient’...

GeneralOASIS ItemConventions
5. Some items allow a dash response.
 Adash (–) value indicates that no information
is avail...

GeneralOASIS ItemConventions
6. Responses to items documenting a patient’s
current status should be based on observation
a...

General OASIS ItemConventions
7. Assessment strategies to complete any and all OASIS
items include the following, unless o...

GeneralOASIS ItemConventions
8. When an OASIS item refers to assistance, this means
assistance from another person.
9. Com...

General OASIS ItemConventions
12. Stay current with evolving CMS OASIS guidance via updates
to the guidance manual and pos...

GeneralOASIS ItemConventions
15.The use of the terms:
– “Specifically,” means scoring of the item
should be limited to onl...

Conventions Specific toOASIS M1800
ADL/IADLItems
1. Report the patient’s physical and cognitive ability to
perform a task....

Conventions Specific toOASIS M1800
ADL/IADLItems
3. While the presence or absence of a caregiver may
impact the way a pati...

Conventions Specific toOASIS M1800
ADL/IADLItems
4. The level of ability refers to the level of assistance that
the patien...

ConventionsSpecifictoOASISM1800
ADL/IADLItems
5. If the patient’s ability varies between the different
tasks included in a...

OASIS-ESections
OASIS-E includes the following sections:
97
Section Title
A Administrative Information • PatientTracking
...

OASIS-E Sections(cont.)
OASIS-E includes the following sections:
98
Section Title
H Bladder and Bowel
I Active Diagnoses
...

TimePointsfornewitems
99
Section Item Description SOC ROC FU TRN DC DAH
A 1005 Ethnicity x
A 1010 Race x
A 1110 Language x...

TimePointsfornewitems
100
Section Item Description SOC ROC FU TRN DC DAH
A 2122
RouteofCurrentReconciled
MedicationListTra...

TimePointsfornewitems
101
Section Item Description SOC ROC FU TRN DC DAH
B 0200 Hearing x
B 1000 Vision x
B 1300 Health Li...

TimePointsfornewitems
102
Section Item Description SOC ROC FU TRN DC DAH
C 0100
ShouldBriefInterviewfor
MentalStatus(C0200...

TimePointsfornewitems
103
Section Item Description SOC ROC FU TRN DC DAH
D 0150
PatientMoodInterview
(PHQ2-9)
X X X
D 0160...

TimePointsfornewitems
104
Section Item Description SOC ROC FU TRN DC DAH
K 0520
NutritionalApproaches
X X X
N 0415
HighRis...

105

106

107

A1005:Ethnicity-NewItems
108

A1010:Race-NewItems
109

A1005: EthnicityandA1010- Race
 Note: These categories are NOT used to
determine eligibility for participation in
any Fed...

111
A1005: EthnicityandA1010- Race
Patient able to respond
Patient unable to
respond
Patient declines to
respond
 Checkal...

Codinginstructions
A1005- Ethnicity&A1010-Race
 Code X, Patient unable to respond:
– If the patient is unable to respond....

Codinginstructions
A1005-Ethnicity&A1010-Race
 CodeY(Patient declines to respond), in the case that
the patient declines ...

Codinginstructions-A1010:Race
Code Z, None of the above, if:
– The patient reports or it is determined
from proxy or medi...

115

A1110: Language- New Items
The intent of this item is to identify the patient’s self-reported
preferred language and need...

A1110A:WhatisyourPreferred
Language

Codinginstructions-A1110:Language
 Enter the preferred language the patient primarily
speaks or understands
 Dash is a v...

Codinginstructions-A1110A:Language
 Note: An organized system of signing, such as
American Sign Language (ASL), can be
re...

A1110B:WhatisyourPreferred
Language

Codinginstructions-A1110B:Language
 Code 0, No, if the patient:
– Indicates does not want or need of an interpreter
to co...

Codinginstructions-A1110B:Language
 Code 9, Unable to determine:
– If no source can identify whether the patient
needs or...

New Item (SDOH)-
SectionA
A1250: Transportation
123

A1250: Transportation
124

A1250:Transportation
 The intent of this item is to identify access to transportation for
ongoing health care and medicat...

Codinginstructions-A1250:Transportation
CodeA,Yes:
 If the patient indicates that lack of
transportation has kept the pa...

Codinginstructions-A1250:Transportation
Code B,Yes:
 If the patient indicates that lack of
transportation has kept the p...

Codinginstructions-A1250:Transportation
 Code C, No:
 If the patient indicates that a lack of transportation
has not kep...

Codinginstructions-A1250:Transportation
 Code X, Patient unable to respond, if the patient is unable to respond.
 In the...

Codinginstructions-A1250:Transportation
CodeY, Patient declines to respond, if the
patient declines to respond.
 In the ...

131

Important Terms
 At the Time of Transfer or Discharge:
– This is the period of time as close to the actual
time of transf...

Important Terms (cont.)
 Current Reconciled Medication List:
– This refers to a list of the patient’s current
medications...

Definitions
 Means of Providing a Current Reconciled Medication
List:
– Providing the current reconciled medication list ...

135

A2120
136

A2121
137

A2120andA2121:ProvisionofCurrent
ReconciledMedicationListtoSubsequentProvider
atTransferandDischarge
 The intent of these...

Coding Instructions-A2120
 For Home Health at Transfer: CompleteA2120 only if:
– M0100,ThisAssessment is Currently Being
...

Coding Instructions-A2121
 For Home Health at Discharge: CompleteA2121 only if:
– M0100, ThisAssessment is Currently Bein...

Coding Instructions-A2120 &A2121
 Code 0, No, if at transfer or discharge to a subsequent
provider, your agency did not p...

Coding Instructions
 A2120 only: Code 2, NA, if:
– At transfer to a subsequent provider, your
agency was not made aware o...

CodingTips (cont.)
 At Transfer-Asubsequent provider is identified
when the patient has transferred to any inpatient
faci...

CodingTips (cont.)
 While the patient may receive care from other providers
after discharge from your agency, these locat...

AdditionalConsiderationsforImportant
MedicationListContent
 Items that could be on a reconciled medication list
include, ...

ImportantMedicationListContent
 Example of medications administered by any route at the
time of discharge or transfer, th...

ImportantMedicationListContent(cont.)
1. Areconciled medication list could include important
information about the patient...

ImportantMedicationListContent(cont.)
2. Areconciled medication list could also include important information
about each m...

ImportantMedicationListContent(cont.)
 Documentation sources for reconciled medication list
information include:
– Electr...

New Item-SectionA
A2123:ProvisionofCurrentReconciled
MedicationListtoPatientatDischarge
150

A2123:ProvisionofCurrentReconciled
MedicationListtoPatientatDischarge
151

Intent of theA2123
 The intent of this item is to identify if the home
health agency provided a current reconciled
medica...

Coding Instructions
 ForHomeHealthatDischarge:CompleteA2123onlyif:
– M0100,ThisAssessmentisCurrentlyBeingCompletedfortheF...

CodingInstructions
Code 0, No, if at discharge to a home setting, your agency
did not provide the patient’s current recon...

Coding Instructions
Patient/family/caregiver:
 In order to code “1.Yes”, a current reconciled
medication list was transf...

NewItems-SectionA
A2122andA2124:RouteofCurrent
ReconciledMedicationList
TransmissiontoSubsequentProvider
andPatient
156

IntentofA2122andA2124
 The intent of these items is to identify all
routes used in the transmission of the current
reconc...

A2122
158

A2124
159

 These items collect important data to monitor how
medication lists are transmitted at
transfer/discharge to the subseque...

CodingInstructions
For Home Health at Transfer, Complete A2122 only if:
 M0100,ThisAssessment is Currently Being
Complet...

CodingInstructions
For Home Health at Discharge, Complete A2122 only if:
 M0100, ThisAssessment is Currently Being Compl...

CodingInstructions
ForHomeHealthatDischarge completeA2124onlyif:
 M0100,ThisAssessmentisCurrentlyBeingCompletedfortheFol...

CodingInstructions
CodeA2122A/A2124A, Electronic Health Record (EHR), if
 Your agency has an EHR and used it to transmit...

CodingInstructions
 CodeA2122B/A2124B, Health Information
Exchange (HIE),
– If your agency participates in a Health
Infor...

Coding Instructions
 CodeA2122C/A2124C, Verbal, if:
– The current reconciled medication list information was
verbally com...

Coding Instructions
 CodeA2122E/A2124E, Other Methods, if:
– The current reconciled medication list was
transmitted to th...

168

169

B0200.Hearing
170

Coding Instructions
 Code 0,Adequate, when the patient has no
difficulty hearing:
– In normal conversation.
– In social i...

CodingInstructions
 Code 1, Minimal difficulty, when the patient:
– Has difficulty in some environments.
– Hears speech a...

CodingInstructions
 Code 2, Moderate difficulty, if:
– Speaker has to increase volume and speak
distinctly.Although heari...

CodingInstructions
 Code 3, Highly impaired, if:
– Absence of useful hearing.
– The patient hears only some sounds and fr...

175

B1000.Vision
176

B1000.Vision
 The intent of this item is to identify the
patient’s ability to see objects nearby:
– In their environment....

 Ask the patient, family, caregivers and/or staff,
if possible, about the patient’s usual vision
patterns.
 Ensure that ...

Definition
 Adequate Lighting:
– Lighting that is sufficient or comfortable
for a person with normal vision to see
fine d...

Coding Instructions
 Code 0,Adequate, if :
– The patient sees fine detail, including regular print in
newspapers/books.
...

CodingInstructions
 Code 3, Highly impaired, if the patient’s:
– Ability to identify objects nearby in their
environment ...

 If the patient is unable to communicate or follow your
directions for testing vision, observe the patient’s eye
movement...

183

B1300.HealthLiteracy
 The intent of this item is to identify the patient’s
self-reported health literacy. 184

 Health literacy is defined as the degree to
which individuals have the capacity to obtain,
process, and understand basic...

 Note:
– This item is intended to be a patient self-report item.
– No other source should be used to identify the
respons...

 Complete this item:
– As close to the time of SOC/ROC as
possible, and
– Within three days of discharge.
187
Coding Inst...

CodingInstructions
Code 0, Never, if the patient indicates never needing help
reading instructions, pamphlets, or other w...

CodingInstructions
 Code 3, Often, if the patient indicates often
needing help reading instructions, pamphlets, or
other ...

CodingInstructions
 Code 7, Patient declines to respond, if the patient
declines to respond.
 Code 8, Patient unable to ...

191

SectionC- CognitivePatterns
 This section contains guidance for nine items
that assess cognitive function including:
– Th...

New itemsin SectionC
 New items include:
– C0100: Should Brief Interview for Mental
Status (C0200-C0500) be Conducted?
– ...

Existing items in Section C
 Existing items in this section include:
– M1700- Cognitive Functioning.
– M1710- When Confus...

New Item-Section C
C0100- ShouldBriefInterviewfor
MentalStatusbeConducted?
195

C0100.ShouldBriefInterviewforMentalStatus
beConducted?
 The intent of this item is to identify if the Brief Interview
for...

 Interact with the patient using their preferred language.
– Be sure the patient:
• Can hear you, and/or
• Has access to ...

Coding Instructions
Code 0, No, if the interview should not be
conducted because:
– The patient is rarely/never understoo...

CodingInstructions
 Code 1,Yes, if the interview should be conducted
because:
– The patient is at least sometimes underst...

200

C0200- RepetitionofThreeWords
201

C0300: TemporalOrientation
202

C0400: Recall
203

C0500: BIMSSummaryScore
204

Intent
 The intent of this item is to determine the
patient’s:
– Attention.
– Orientation.
– Ability to register and reca...

Nonsensical Response is any response that is:
– Unrelated.
– Incomprehensible.
– Incoherent.
– It is not informative with...

The BIMS interview is considered complete if:
– The patient attempted and provided relevant
answers to at least four of t...

 Interview any patient not screened out by item C0100 (Should
Brief Interview for Mental Status Be Conducted?)
 Conduct ...

Give an introduction or provide a written introduction, as
appropriate before starting the interview.
•Suggested language...

If the patient expresses concern that you are
testing their memory, they may be more
comfortable if you reply:
•“We ask t...

 Directly ask the written questions, each item in C0200
through C0400 at one sitting and in the order provided.
 If the ...

 For C0200 items, instructions should be written as
follow:
– “I have written 3 words for you to remember.
Please read th...

 Category cues should be provided to the
patient in writing after the patient’s first
attempt to answer.
 Written catego...

 For C0300 items, instructions should be written as:
– C0300A: “Please tell me what year it is right
now.”
– C0300B: “Wha...

For C0400 items, instructions should be
written as:
– “Let’s go back to an earlier question.
What were those three words ...

 If the patient is unable to remember a word, provide
Category cues again, but without using the actual word.
Therefore, ...

Coding Instructions
 If SOC/ROC assessment;
– Collect as close to the time of SOC/ROC as possible.
 If discharge assessm...

Codingtips
 Code “0” is used to represent three types of
responses:
1. Incorrect answers.
2. Nonsensical responses.
3. Qu...

RulesforStoppingtheBIMsInterview
 Rules for stopping the BIMS interview before it is complete:
– Stop the interview after...

Codingtips
 If the interview is stopped, do the following:
– Code “-” (dash) in C0400A, C0400B, and
C0400C.
– Code 99 in ...

CueCards for BIMS
Written Introduction Card – BIMS – Items C0200-C0400
221
I would like to ask you some questions, which ...

WrittenInstructionCards–ItemC0200–
RepetitionofThreeWords
222
I have written 3 words for you to remember.
Please read them...

WordCards – ItemC0200
223

CategoryCue Cards –ItemC0200
224

WrittenInstructionCards–ItemC0300–Temporal
OrientationStatementCard-C0300A-Year
225

QuestionCards–ItemC0300B-Month
226
What month are we in
right now?

QuestionCards–ItemC0300C-Day
227

WrittenInstructionCards–ItemC0400-Recall
228

CategoryCueCards–ItemC0400A-Sock
229

CategoryCueCards–ItemC0400B-Blue
230

CategoryCueCards–ItemC0400C-Bed
231

232

C0200- Repetitionof ThreeWords
233

Category Cue define as:
–Phrase that puts a word in context to help with
learning and to serve as a hint that helps promp...

For C0200: Repetition of Three Words:
– Tell patient: “I am going to say three words
for you to remember. Please repeat t...

– Immediately after presenting the three words, say to
the patient: “Now please tell me the three words.”
– After the pati...

 After the patient’s first attempt to repeat the items:
– If the patient recalled two or fewer words, code C0200,
Repetit...

– If the patient still does not recall all three words
correctly, you may repeat the words and
category cues one more time...

Coding Instructions
 Code “0, none” if :
– The patient did not repeat any of the 3 words on the first attempt.
 Code “1,...

240

C0300: TemporalOrientation
241

Temporal Orientation
– Is the ability to place oneself in correct
time.
– For the BIMS, it is the ability to indicate
the...

For C0300 (A, B, and C) - Temporal
Orientation:
– Ask the patient each of the 3 questions in
Item C0300 separately.
– All...

244

WrittenInstructionCards–ItemC0300–Temporal
OrientationStatementCard-C0300A-Year
245

C0300: TemporalOrientation
246

CodingInstructionsforC0300A-Ableto
reportCorrectyear
 Code 0, missed by > 5 years or no answer, if:
– The patient’s answe...

CodingInstructionsforC0300A-Ableto
reportCorrectyear
 Code 1, missed by 2-5 years, if:
– The patient’s answer is incorrec...

CodingInstructionsforC0300A-Ableto
reportCorrectyear
 Code 3, correct, if :
– The patient states the correct year.
 Dash...

250

QuestionCards–ItemC0300B-Month
251
What month are we in
right now?

C0300: TemporalOrientation
252

CodingInstructionsfor C0300B-
Able toreportCorrectMonth
 Count the current day as day 1 when
determining whether the resp...

CodingInstructionsforC0300B-Ableto
reportCorrectMonth
Code 0, missed by >1 month or no answer,
if :
– The patient’s answe...

CodingInstructionsforC0300B-Ableto
reportCorrectMonth
 Code 1, missed by 6 days to 1 month, if:
– The patient’s answer is...

256

QuestionCards–ItemC0300C-Day
257

C0300: TemporalOrientation
258

CodingInstructionsforC0300C-Ableto
reportCorrectDayoftheWeek
 Code 0, incorrect, or no answer, if :
– The answer is incor...

260

C0400: Recall
261

 For C0400 (A, B, and C): Recall:
– Ask the patient the following: “Let’s go
back to an earlier question. What were
those...

WrittenInstructionCards–ItemC0400-Recall
263

 For C0400 (A, B, and C): Recall:
– Allow up to 5 seconds for spontaneous recall of each word.
– For any word that is not...

CategoryCueCards–ItemC0400A-Sock
265

CategoryCueCards–ItemC0400B-Blue
266

CategoryCueCards–ItemC0400C-Bed
267

CodingInstructionsfor C0400A-C
Code 0, no - could not recall, if:
– The patient cannot recall the word even
after being g...

Coding Instructionsfor C0400A-C
 Code 1, yes, after cueing, if:
– The patient requires the category cue to
remember the w...

CodingTips
 If on the first try, the patient names multiple items in
a category, one of which is correct, they should be
...

271

C0500: BIMS SummaryScore
272

 Scores from a carefully conducted BIMS
assessment where patients can hear all questions
and the patient is not delirious...

Coding Instructions
 Enter the total score as a two-digit number.
 The total possible BIMS score ranges from “00” to “15...

Coding Instructions(cont.)
 To be considered a completed interview,
the patient had to attempt and provide
relevant answe...

CodingInstructions
 Code 99, unable to complete interview, if;
(a) The patient chooses not to participate in the
BIMS.
(b...

CodingTips
 Occasionally, a patient can communicate but
chooses not to participate in the BIMS and
therefore does not att...

278

C1310- SignsandSymptomsofDelirium
279

C1310- SignsandSymptomsof
Delirium
The intent of this item is to identify any
signs or symptoms of acute mental status
ch...

 Delirium is a mental disturbance characterized
by:
– New or acutely worsening confusion.
– Disorder expression of though...

 Examples of acute mental status changes include:
– Apatient who is usually noisy or belligerent
becomes quiet, lethargic...

Fluctuation:
– The behavior tends to come and go and/or Increase
or decrease in severity.
– The behavior may fluctuate ov...

C1310A,AcuteMentalStatus
Change
284

CodingInstructionsforC1310A,AcuteMental
StatusChange
 Code 0, no, if:
– There is no evidence of acute mental status chang...

C1310B, Inattention
286

Inattention:
– Reduced ability to maintain attention to
external Stimuli and to appropriately shift
attention to new exte...

Coding Instructionsfor C1310B,
Inattention
 Code 0, behavior not present, if:
– The patient remains focused during the
as...

CodingInstructionsforC1310B,Inattention
 Code 1, behaviorcontinuously present, does not
fluctuate, if :
– The patient had...

CodingInstructionsforC1310B,Inattention
 Code 2, behaviorpresent, fluctuates, if inattention is
noted during the assessme...

CodingInstructionsforC1310B,Inattention
 Dash is a valid response for this item.
– Dash indicates “no information.”
– CMS...

292
C1310C-Disorganized Thinking

Disorganized Thinking evidenced by:
– Rambling,
– Irrelevant, or
– Incoherent speech.
293
Definition-Disorganized Thinking

CodingInstructionsforC1310C,
DisorganizedThinking
Code 0, behavior not present, if:
– All sources agree that the patient’...

CodingInstructionsforC1310C,
DisorganizedThinking
 Code 1, behavior continuously present, does not fluctuate,
if during t...

CodingInstructionsfor C1310C,
DisorganizedThinking
 Code 2, behavior present, fluctuates, if during
the assessment or acc...

297
C1310D-AlteredLevelofConsciousness

AlteredLevelof Consciousness
Vigilant
Startles
easilytoany
soundor
touch
Lethargic
Repeatedlydoze
offwhenyouare
askingques...

CodingInstructionsforC1310D,
AlteredLevelofConsciousness
 Code 0, behavior not present, if:
–All sources agree that the p...

CodingInstructionsforC1310D,
AlteredLevelofConsciousness
 Code 1, behaviorcontinuously present, does not
fluctuate, if du...

CodingInstructionsforC1310D,
AlteredLevelofConsciousness
 Code 2, behaviorpresent, fluctuates, if:
– During the assessmen...

C1310A, C1310B,C1310C and
C1310D
 Dash is a valid response for these items.
– Dash indicates “no information.”
– CMS expe...

303

304

305
OR
and either

306
OR

307

SectionD
 New items in this sections are included:
– D0150- Patient Mood Interview (PHQ-2
to PHQ-9)
– D0160- Total Severi...

309

NEW-D0150-PatientMoodInterview
(PHQ-2toPHQ-9)
310

NEW-D0150-PatientMoodInterview
(PHQ-2toPHQ-9)
311
PHQ-2
PHQ-9
Theremaining7questions

 Patient Health Questionnaire (PHQ-2 to PHQ-
9):
– Avalidated interview that screens for
symptoms of depression.
– It pro...

 If the patient appears unable to communicate,
offer alternatives such as:
– Writing,
– Pointing,
– Sign language, or
– C...

 If an interpreter is used during patient interviews,
the interpreter should not attempt to determine:
– The intent behin...

315
CueCard
0-1 (Never or 1 day)
2-6 days (several days)
7-11 days (half or more days)
12-14 days (nearly every day)

NEW-D0150-PatientMoodInterview
(PHQ-2toPHQ-9)
316

For each of the questions:
– Read the item as it is written.
– Do not provide definitions.
– Each question must be asked ...

 Enter code “9” if :
– The patient was unable to complete the interview.
– Chose not to complete the interview.
– Respond...

319
Response-SpecificInstructions

320
Response-SpecificInstructions
If the patient
rarely/never
understood
1. Code D0150A1 & D0150B1
“9.”
2. Leave D0150A2 a...

321
Response-SpecificInstructions
 If both D0150A2 and
D0150B2 are less than
2.
1. There is no need to continue
to the PH...

322
Response-SpecificInstructions
 If both D0150A2
and D0150B2 are
Blank:
1. End the PHQ-2,
and
2. Skip D0160.

323
Response-SpecificInstructions
 If both D0150A2
and D0150B2 are
Coded 9:
1. Leave D0150A2 and
D0150B2 Blank, then
2. E...

324
Response-SpecificInstructions
 If either
D0150A2 or
D0150B2 are 2
or 3:
1.Complete the PHQ-9.
2.Proceed to ask the
re...

325
Response-SpecificInstructions
 If D0150A2 is
0 or 1, and
 D0150B2 is 2
or 3:
1.Complete the PHQ-9.
2.Proceed to ask ...

326
Response-SpecificInstructions
 If D0150A2 is 2
or 3, and
 D0150B2 is 0 or
1:
1.Complete the PHQ-9.
2.Proceed to ask ...

327
D0150:Column1.SymptomPresence.
CodingInstructions

CodingInstructionsforColumn1:SymptomPresence
328

CodingInstructionsforColumn1:SymptomPresence
329

CodingInstructionsforColumn1:
SymptomPresence
 Code 0, no: if:
– Patient indicates symptoms listed are not present.
– Ent...

 Enter code “9” if :
– The patient was unable to complete the interview.
– Chose not to complete the interview.
– Respond...

Dash is a valid response for this item.
– Dash indicates “no information.”
– CMS expects dash use to be a rare
occurrence...

CodingInstructionsforColumn2:SymptomFrequency
333

Coding Instructionsfor Column2:
SymptomFrequency
 Code 0, never or 1 day, if:
– The patient indicates that during the pas...

CodingInstructionsforColumn2:
SymptomFrequency
 Code 1, 2-6 days (several days), if:
– The patient indicates that during ...

CodingInstructionsfor Column2:
SymptomFrequency
 Code 3, 12-14 days (nearly every day), if:
– The patient indicates that ...

337
CodingTips
 If the patient has
difficulty selecting
between two frequency
responses:
 Code for the higher
frequency.

338
CodingTips
 If Column 1 equals 0,  Enter 0 in Column 2
 If Column 1 equals 9,  Leave Column 2 blank

339
CodingTips
 If the patient describes
the presence of a
symptom, but cannot
quantify a frequency:
 Code the presence ...

340
CodingTips
 If a patient gives
different frequencies
for the different parts
of a single item:
 Select the highest
f...

CodingTips
 Patients may respond to questions:
– Verbally,
– By pointing to their answers on the cue
card, or
– By writin...

InterviewingTips and Techniques
If the patient has difficulty selecting a
frequency response, start by offering a single
...

InterviewingTips and Techniques
Patients may be reluctant to report symptoms
and should be gently encouraged to tell you ...

InterviewingTips and Techniques
 To narrow the answer to the response choices
available, it can be useful to summarize th...

InterviewingTips and Techniques
 If the patient has difficulty with longer
items, separate the item into shorter parts,
a...

346

D0160- Total SeverityScore
 The intent of this item is to identify the severity
score calculated from responses to the PH...

348
ScoringRules

ScoringRules
The maximum patient score for the Patient Mood
Interview Total Severity Score D0160 is 27 (3x9).
The Total ...

350
Response-SpecificInstructions
 If both D0150A2 and
D0150B2 are Coded
9:
1. Leave D0150A2 and
D0150B2 Blank, then
2. E...

351
Response-SpecificInstructions
 If no assessment is
conducted for
Symptom Presence:
1. Enter a dash (-) in
Column 1,
2...

ScoringRules-Column1and 2
If only the PHQ-2 is
completed because both
D0150A2 and
D0150B2 are less than
2 then:
352
Add ...

ScoringRules-Column1and 2
If the PHQ-9 was
completed; and
If the patient answered the
frequency responses of at
least 7 ...

EXAMPLE
354

ScoringRules-Column1and 2
 If symptom frequency
in items D0150A2
through D0150I2 is
blank for 3 or more
items:
355
 The ...

EXAMPLE
356

CodingTips
 Responses to PHQ-2 to 9 can be interpreted as
follows:
– Major Depressive Syndrome is suggested if-- of
the 9...

CodingTips
– Minor Depressive Syndrome is suggested if of the 9
items, the following items are identified at a frequency
o...

CodingTips
 Total Severity Score can be interpreted as follows:
359
Score Interpretation
0-4 Minimal depression
5-9 Mild ...

ScoringRules:PatientMoodInterviewTotal
SeverityScoreD0160
 The score in item D0160 is based upon the sum of the values th...

RulesHowtoComputetheScoreforitem
D0160
 These rules consider the "number of missing items in
Column 2" which is the numbe...

ScoringRules: PatientMoodInterview
TotalSeverityScoreD0160
 If all of the items in
Column 2 have a value
of 0, 1, 2, or 3...

ScoringRules: PatientMoodInterview
TotalSeverityScoreD0160
 If any of the items in
Column 2 are skipped or
equal to dash,...

ScoringRules:PatientMoodInterviewTotal
SeverityScoreD0160
 If the number of
missing items in
Column 2 is equal to
one, th...

ScoringRules:PatientMoodInterviewTotal
SeverityScoreD0160
 If the number of
missing items in
Column 2 is equal to
two, th...

ScoringRules:PatientMoodInterviewTotal
SeverityScoreD0160
 If the number of
missing items in
Column 2 is equal to
three o...

367

D0700- SocialIsolation-New
 The intent of this item is to identify the patient’s actual or
perceived lack of contact with...

Definitionof SocialIsolation
 Social isolation refers to an actual or perceived
lack of contact with other people, such a...

Response –specific Instructions
 This item is intended to be a patient self-report
item.
 No other source should be used...

Coding Instructions
 Code 0, Never, if the patient indicates never feeling
lonely or isolated from others.
 Code 1, Rare...

Coding Instructions
 Code 4,Always, if the patient indicates always
feeling lonely or isolated from others.
 Code 7, Pat...

373

374

375
GG0100:PriorFunctioningItemRevisions

 Code 3, Independent, If the patient completed ALLthe
activities by themselves with or without an assistive
device, with ...

 Code 8, Unknown, if the patient’s usual ability
prior to the current illness, exacerbation, or injury is
unknown.
 Code...

 For GG0100-Prior Functioning: EverydayActivities:
– Report the patient’s functional ability prior to the onset of the
cu...

379

380
GG0110: PriorDeviceUse

 For GG110. Prior Device Use:
– Report the devices used by the patient prior to the onset of the
current illness, exacerb...

 GG0110C, Prior Devices: Mechanical lift
Includes any mechanical device or equipment
a patient or caregiver requires for ...

 Examples include, but are not limited to:
– Stair lift,
– Hoyer
– Bathtub lift,
– Sit-to-stand lift,
– Stand assist,
– E...

 GG0110D, Walker refers to all types of
walkers. Examples include, but are not limited
to,
– Pick-up walkers,
– Hemi-walk...

 Code Z, None of the above, if the patient did not
use any of the listed devices or aids immediately
prior to the current...

386

 Licensed clinician may assess the patient’s self-care and
mobility performance based on:
 Direct observation (preferred...

 Guidanceonhowtocodeanactivitywhenonlyaportionof
theactivityhasbeencompleted:
 If the patient only completes a portion o...

 If the clinician determines that this observation is
adequate, code based on the type and amount of
assistance the patie...

 When a function activity is not completed
entirely during one clinical observation,
code based on the type and amount of...

The time period under consideration is the look-back
period to use when coding each OASIS item.
 For most items, the loo...

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