OASIS C2.

OASIS C2

Objectives Identify changes to the OASIS question format and minor wording changes Identify changes to guidance Outline new questions and guidance associated with completion Today our objectives are:

Minor Wording Changes Old: Since the previous OASIS
New: Since the most recent SOC/ROC assessment Align with quality episode OASIS C1-ICD10 OASIS C2 M1500 M1501 M1510 M1511 M2004 M2005 M2015 M2016 M2300 M2301 M2400 M2401 The first minor wording change exists with those M items that look back in an episode of care to determine either education, symptom, interventions or urgent care. The old language had the assessing clinician looking back to the previous OASIS assessment. The language in the new question has the look back to the most recent SOC/ROC assessment which may be a longer period of time. This is logical as it aligns with the quality episode methodology. As a reminder, the quality episode begins at SOC or ROC and ends with a Transfer or Discharge.

Longer Lookback Period
Minor Wording Changes Longer Lookback Period This is what the new wording looks like in an OASIS question with the longer look back period.

Format changes Enter code box No change to content
Many questions throughout assessment Aligns OASIS format with MDS used in SNF July Q&A Question 2: We utilize an electronic medical record. Do the formatting changes added to OASIS-C2 regarding the single box entry need to be presented to the clinicians in the EMR? The end result in the extract is the same. Currently the response options are presented to the clinicians in a list with radio buttons to indication response selection. Is this acceptable? Answer 2: In the development and maintenance of OASIS-C2 Assessment user tools, Vendors are advised to reference the Data Specifications v ( Patient-Assessment-Instruments/OASIS/DataSpecifications.html). While the Data Specifications dictate the Assessment Instrument Items, their applicable time point(s) in the Assessment Instrument, the exact language of the Items, and each Item’s allowable response options, the Data Specifications do not dictate the format of the graphical user interface (GUI) software presentation of the Items in the Assessment Instrument. Per your example, presenting the allowable response options in the format of radio buttons in the GUI software is acceptable, and is left to the user’s discretion, as long as such modification does not impact the accuracy of the item scoring. The next change is only a formatting change. You will see this formatting change throughout the OASIS assessment. Today we answer the OASIS by competing a selection next to each of the options in an individual question. Going forward the assessing clinician will enter the response number into an “enter code” box. This format is the same as other settings like the skilled nursing facilities and their Minimum Data Set (MDS) assessment. You will note CMS has provided guidance we do not need to change our EMR to match exactly, so you will not see

Format change example OASIS C-1 OASIS C2 Kindred Link
This is the example of how you see the selection box changing. Because of the flexibility given to EMR’s you will not see changes as you can tell from the Gender question from KindredLink. This is throughout the assessment.

Drug Regimen Review As we begin to talk about the drug regimen review, one of the big changes here is the need to communicate and resolve only issues that are clinically significant. In OASIS C1, the question included a list of examples of clinically significant issues and gave no further definition on identifying which issues are significant. The guidance for C2 now clearly gives this determination to the assessing clinician. To be considered in M2001, circumstances must reach a level of clinical significance, in the judgement of the assessing clinician, that warrants notification of the physician for orders or recommendations by midnight of the next calendar day, at the latest. Any circumstance that does not require this immediate attention is not considered a potential or actual clinically significant medication issue. If you are using clinical judgement to determine that a potential issue is not significant for a specific patient that would normally be considered a problem, be sure to write a note on your assessment to explain the circumstance. Did a complete drug regimen review identify potential clinically significant medication issues?

Drug Regimen Review Renumbering also M2005 (M2004) and M2016 (M2015)
As we look at the side-by-side comparison of the questions you can see the examples that were present in OASIS C1. The other change you see as we look at the questions is the options for answering. The numbering has changed as well as the removal of the option for “Not assessed/reviewed”. The drug regimen review is required in the comprehensive assessment by the conditions of participation and would never be answered as Not assessed. The options that remain are the same as in OASIS C1. These will be presented to you as choices in KindredLink so that you can click on your answer rather than entering in the box as you see here. Renumbering also M2005 (M2004) and M2016 (M2015)

Medication Reconciliation
Clarified timing of response from MD as midnight of the next calendar day Includes completion of recommended actions OASIS C1-ICD10 OASIS C2 M2002 M2003 M2004 M2005 The next component of the drug regimen questions that has changed is the timing of the response from the physician. The question now specifically states that physician contact and completion of recommended actions must take place by midnight of the next calendar day. Previous wording only required the communication with the physician to occur in that timeframe and was a bit more vague by saying it had to happen within one calendar day. For OASIS C2, we now know that our follow up actions with the patient also must occur by midnight of the following day. You can see in the Q&A included on this slide and in the guidance for C2 that is published by CMS that they are clear about the requirements to mark response 1. Let’s take a look at the OASIS questions so you can see the wording changes

Clarification of Timing This side-by-side comparison of the Medication follow up questions from C1 and C2 is simply to illustrate the difference in the two questions with regard to timing. The C1 version is on top with the modification in C2 highlighted below.

Change in wording to indicate HHA completed recommended actions given by physician Here we have the highlighted change that adds the requirement to act upon the physician’s order and/or recommendation to correct the medication issue within the same calendar day. In order to take credit for the action, the agency must receive the communication from the physician and act upon it. If the physician’s office contacts the patient directly and never contacts the agency to relay the change, then you cannot answer yes to this question. You cannot take the order from your patient so make sure you are involved in that communication directly from the physician or agent.

Clarification in wording indicates that medication reconciliation is expected EACH time clinically significant issues are found – Not just at OASIS time points M2005 is answered at transfer and discharge and requires you to look back over the course of care back to the SOC or ROC. In C1 you were only asked to go back to the last OASIS which might have just been a recert, so this is a more significant timeframe and ties this outcome related question to the entire quality episode. So, we look back over the whole quality episode that began with the SOC/ROC and determine whether or not we communicated with the physician and took action EACH TIME a potentially clinically significant issue was identified. This means we consistently evaluated medications throughout the course of care and not just at OASIS timepoints. The question will require some significant chart review to obtain an accurate answer if the clinician completing this transfer or discharge has not been actively caring for the patient.

Dash in Medication Questions
M2001 Medication Regimen Review and M2003 Medication Follow up Dash allowed No information available Item cannot be assessed Rare occurrence The OASIS C2 guidelines from CMS allow for the dash to be used in questions M2001 and M2003, however, the Drug Regimen review is required by CoPs as part of the comprehensive assessment. CMS expects this to be extremely rare.

Wound Status All pressure ulcer questions
Now use of Arabic numbers versus Roman Numerals Roman Numerals Standard Stage I Stage 1 Stage II Stage 2 Stage III Stage 3 Stage IV Stage 4 Now let’s move on to the wound questions The first change you will notice is the move from using Roman Numerals to Arabic. This is one of the changes that moves us toward standardization with other post-acute assessments.

Pressure Ulcers Do not reverse stage a pressure ulcer. Consider the ulcer at its worst until healed. All pressure ulcers can heal Stage 1 no longer red/non-blanchable Stage 2,3,4 completely covered in epithelial tissue Once healed the wound is no longer reported as a pressure ulcer Previously healed stage 3 or 4 that reopens at the same site is reported at its worst previous stage A few notes about pressure ulcers in general. There are a few new points listed here, but most should serve as a reminder. Read slide The one item that stands out is once a pressure ulcer is healed it is no longer reported as a pressure ulcer. We will talk more about this in the next slides.

Pressure Ulcers Assessing clinician may report a pressure ulcer and stage without physician confirmation per OASIS guidance Coding conventions require confirmation Pressure ulcer covered with slough/eschar is not stageable but is observable to assess healing status A pressure ulcer that has been debrided is still a pressure ulcer A pressure ulcer that is treated with a muscle flap or skin graft becomes a surgical wound A couple more reminders here OASIS allows the clinician to assess per OASIS guidelines a pressure ulcer without physician confirmation (see Q&A A89.4) however diagnosis coding does require physician confirmation. Pressure ulcers covered with escar cannot be staged, but you can report healing status A pressure ulcer that has been debrieded is still a pressure ulcer (not new) However if there is a muscle flap or skin graft you now have a surgical wound. The skin graft is new guidance.

Pressure Ulcers If any bone, tendon or muscle or joint capsule (Stage 4 structures) is visible, the pressure ulcer should be reported as a Stage 4 pressure ulcer, regardless of the presence or absence of slough and/or eschar in the wound bed. This slide is also updated guidance regarding stage 4 pressure ulcers where there is the presence of bone, tendon, muscle or joint capsule visible.

M1306 Unhealed Pressure Ulcer
Healed = Closed Unhealed = Open Do not change assessment for an ulcer that increases in numerical stage within the assessment time period (5 day window) As you consider M1306 and the presence of an unhealed pressure ulcer, there are some changes in C2 to again support the standardization across environments of care. This question is answered at all timepoints. Two new things to consider here: First, the words ‘healed’ and ‘unhealed’ generally refer to whether the wound is closed or open. Second, you should not change an assessment of an ulcer that increases in numerical stage within the assessment time period which is the 5 day window. If a wound is unstageable at SOC and then the wound is debrided and you are now able to see the wound bed, you would leave the original assessment as unstageable. This most accurately shows the progression of the wound from SOC. This is different from the logic used on some other OASIS questions where you might consider information obtained later to complete the assessment. For pressure ulcers, you need to stick with the original SOC assessment.

M1307 Oldest stage 2 Enter Response 1 only if the oldest Stage 2 pressure ulcer that is present at discharge was already present as a Stage 2 pressure ulcer when first assessed at the SOC/ROC. Enter Response 2 if the oldest Stage 2 pressure ulcer that is present at discharge was NOT a Stage 2 pressure ulcer at the most recent SOC/ROC. Then, enter the date that it was identified as a Stage 2. Do not consider suspected Stage 2 wounds that are currently not observable In M1307 the change is to the written guidance, but will not change how we assess this question. In the manual they clarified you are reporting only if the oldest Stage 2 pressure ulcer that is present at discharge was already present as a Stage 2 pressure ulcer when first assessed at the SOC/ROC. This makes response two now – only if the oldest Stage 2 pressure ulcer that is present at discharge was NOT a Stage 2 pressure ulcer at the most recent SOC/ROC. For example = If no pressure ulcer existed at the SOC, then a Stage 1 pressure ulcer developed, which progressed to a Stage 2 by discharge, enter Response 2, and specify the date that the pressure ulcer was first identified as a Stage 2 ulcer.

Wound Status Answer at SOC, ROC, Recert, DC
M1311 asks for a count of unhealed pressure ulcers at each stage. At SOC and ROC you will only be answering A1, B1, and so on by giving a count of the number of ulcers present at each stage. When you get to a recertification or discharge, you will also answer part 2 at each stage. This part of the question asks you to identify how many of those particular wounds were present at SOC. If the wound was unstageable at the SOC/ROC, go forward in the record until the first time it was staged. If the original stage is the same as the stage at follow up/d/c you will count that wound. For example, pt has a wound covered with eschar at SOC and two weeks later the wound is debrided and assessed as Stage 3. Upon recert the wound has remained unhealed so it is still Stage 3. You would count the wound in B1 and in B2 since the first noted stage was also a stage 3. This question tells CMS the state the patient was in when you received them and whether the patient has maintained or declined. If a wound was not present at SOC, but is present at Recert or d/c, it tells a story of the patient’s experience in home care.

Remember M1308 from OASIS C? If you have been in home care long enough to remember OASIS C, then this question probably looks familiar to you. It was previously present as M1308 and has returned in the latest version of OASIS

M1311 Current Number If the pressure ulcer was unstageable at SOC/ROC, but becomes numerically stageable later, when completing the Discharge assessment, its “Present on Admission” stage should be considered the stage at which it first becomes numerically stageable. If it subsequently increases in numerical stage, do not report the higher stage ulcer as being “present at SOC/ROC” when completing the Discharge assessment. If a pressure ulcer that is identified on the SOC date increases in numerical stage (worsens) within the assessment time frame, the initial stage of the pressure ulcer would be reported in M1311 at the SOC Here are two new paragraphs added to the guidance manual. The first provides guidance when you have an unstagable pressure at SOC/ROC - use the stage at which it first became stagable not the worse stage. The second the guidance around assessing at the time of initial assessment.

M1311 Current Number Multiple responses for unstagable
At the end of M1311, there are multiple responses available for wounds that are unstageable. A wound may be unstageable due to a non-removeable dressing, slough or eschar, or it may be suspected deep tissue injury. Pressure ulcers that are known to be present but that are Unstageable due to a dressing/device, such as a cast that cannot be removed to assess the skin underneath, should be reported as D1 (Unstageable). “Known” refers to when documentation is available that states a pressure ulcer exists under the non-removable dressing/device. Examples of a non-removable dressing/device include a dressing that is not to be removed per physician’s order (such as those used in negative-pressure wound therapy [NPWT], an orthopedic device, or a cast. Multiple responses for unstagable Non-removable dressing: Ulcer must be ‘known’ to be present in order to be counted

M1313 Worsening in Pressure Ulcer Status Since SOC/ROC
Question wording: OASIS C1-ICD10 – M1309 Instructions for a – c: For Stage II, III and IV pressure ulcers, report the number that are new or have increased in numerical stage since the most recent SOC/ROC OASIS C2 – M1313 Instructions for a-c: Indicate the number of current pressure ulcers that were not present or were at a lesser stage at the most recent SOC/ROC. If no current pressure ulcer at a given stage, enter 0. Question M1313 correlates to M1309 from OASIS C1. This is a discharge question to count the number of ulcers at each stage that were not present or were at a lesser stage at SOC/ROC. You can see the slight change in wording here from wounds that are “new or have increased” to the new wording of “not present or at a lesser stage”. The intent of the question has not changed.

Notice there are now 3 options for unstageable ulcers
M1313 The OASIS will present you with data entry boxes to place your wound count. Again, notice the three options for unstageable ulcers. Pressure ulcers that are unstageable at discharge due to a dressing/device, cannot be reported as new or worsened unless no ulcer existed at the SOC/ROC. If the ulcer is unstageable due to slough, eschar or suspected deep tissue injury AND the wound was either not present, Stage 1 or 2 at SOC, then you would report it as new or worsened. Notice there are now 3 options for unstageable ulcers

M1313 Worsening in Pressure Ulcer
Locate all current Stage 2, 3, 4 and unstageable pressure ulcers. Review the history of each current pressure ulcer and compare the current stage to the stage of the ulcer at SOC/ROC. Follow the algorithm to determine if the wound is reportable as new or worsened. In order to answer M1313, you will need to start by locating all current pressure ulcers. For each ulcer present at discharge, review the history to determine the stage at the SOC/ROC. Count the number of wounds at each stage that were either not present or present at a lesser stage at the SOC. There is an algorithm in Chapter 3 of the OASIS guidance manual that is a helpful resource for this question.

M1313 – Algorithm This is a sample from the algorithm that is available to help you with M1313

M1313 Worsening in Pressure Ulcer
Dash is available as response No information available Item could not be assessed Possibly when a patient is unexpectedly transferred, discharged or dies before assessment could be completed Rare occurrence As we saw in a few other questions, the dash is available as a response. This would likely only be used for an unexpected transfer or discharge or a patient death. CMS expects this to be a rare occurrence.

M1340 Surgical Wound If a pressure ulcer is surgically closed with a flap or graft it is no longer reported as a pressure ulcer. It should be reported as a surgical wound until healed. If the flap or graft fails, it should continue to be considered a surgical wound until healed. Moving on now to surgical wounds… The only change with surgical wounds is one I mentioned in the pressure ulcer section. Surgical wounds now include pressure ulcers that have been closed with a skin graft. All other definitions and questions remain unchanged for surgical wounds.

Other Guidance Changes
Now lets move on to change in guidance

M0090 Date Assessment Completed
If the clinician needs to follow-up, off site, with the patient’s family or physician in order to complete an OASIS or non-OASIS portion of the comprehensive assessment, M0090 should reflect the date that last needed information is collected. If the original assessing clinician gathers additional information during the SOC 5-day assessment time frame that would change a data item response, the M0090 date would be changed to reflect the date the information was gathered and the response change was made. This slide shows two new guidance statements in the manual. Based on Q&A’s this is not a change in direction, just an update to the manual.

M1017 Diagnoses Requiring Treatment
A diagnosis reported in M1011 – Inpatient Diagnosis may also be reported in M1017 if within the 14 days prior to the SOC/ROC date the condition was new or exacerbated, required changes in the treatment regimen AND the patient was discharged from an inpatient facility where the condition was actively treated. The guidance with M1017 clarifies the situation where a diagnosis is listed in M1011 when it should be repeated in M This change in guidance only is when the diagnosis is also listed in M1011, not all codes listed in M1017. The bold/italics text is new – clarifying the diagnosis may be new or exacerbated. They also added Actively to the last component of the guidance.

M1046 Influenza Vaccine With M1046 the direction clarified response 8 also includes when the clinician is unable to determine if the patient received the vaccine. Response 8 includes when assessing clinician is unable to determine whether the patient received the influenza vaccination.

Day Counting Last 14 days at discharge
Use M0090 M0090 date is day 0 and the day immediately prior to M0090 date is day 1 OASIS items M1600 M1710 M1720 For day counting on questions looking back in the patient history, clarification has been added to m1600, M1710 and M Note – this language exists today with questions today like M1005 and M1017.

M1740 Cognitive Symptoms Behaviors reported could be identified by a formal diagnosis and/or determined by the assessing clinician to be associated with a significant neurological, developmental, behavioral and/or psychiatric disorder. This guidance is added to M1740 clarifying that the symptoms may be from formal diagnosis or associated with another disorder.

M1840 Toilet Transferring In the absence of a toilet in the home, the assessing clinician would need to determine if the patient is able to use a bedside commode (Response 2), or if unable to use a bedside commode, if he is able to use a bedpan/urinal independently (Response 3). If the patient is not able to use the bedside commode or bedpan/urinal as defined in the responses If such equipment is not present in the home to allow assessment, then Response 4 – totally dependent in toileting would be appropriate. With M1840 we have a clarification was given in a Q&A response in the past however this broadens the guidance. It assists on how to assess when there is an absence of a toilet in the home.

Let’s now move to the new questions.

New Questions M1028 – Active Diagnoses – Comorbidities – Co-existing Conditions Peripheral vascular disease (PVD) and Peripheral artery disease (PAD) ICD10 code categories I70 - fourth digit of 2, 3, 4, 5, 6, 7, 9, I73 Diabetes ICD10 code categories E08, E09, E10, E11, E13 We start back near the beginning with M CMS is starting to gather the difference between diagnosis that are active or those that are longstanding stable diagnosis for patients. There are only two categories for which this information is reported. Peripheral vascular/artery disease and diabetes. CMS has provided detailed guidance on which codes are included in this response. For peripheral vascular disease the category I70 is included however only with the fourth digit is a 2, 3, 4, 5, 6, 7 or 9. That might make you ask why not 0, 1 or 8? It is because they are not peripheral – 0 is Aorta, 1 is the renal artery and 8 is of other. All the codes in the category of I73 are included as other peripheral vascular diseases. All the diabetes codes are included – due to underlying condition, drug or chemical induced, Type 1 and type 2.

NEW M1028 Active Diagnoses Physician (or other allowed party) confirmed Direct relationship To the patient’s current functional, cognitive, mood or behavior status; medical treatments; nurse monitoring; or risk of death at the time of assessment Do not include resolved diagnoses Use of dash Further guidance with this question is not surprising. A physician (or nurse practitioner, physician assistant, clinical nurse specialist, or other authorized licensed staff if allowable under state licensure laws) must confirm this diagnosis, it is not solely based on our clinician assessment or patient report. To be considered active there must be a direct relationship to the patient’s current functional, cognitive, mood or behavior status; medical treatments; nurse monitoring; or risk of death at the time of assessment. Not unlike M1021, if a diagnosis is resolved it is not included here. And again we see that a dash is an option. In this question the use of a dash should be rare.

New Questions M1060 – Height and Weight Standard mathematical rounding
< .4 – round down > .5 – round up In accordance with company policy and standard of practice Cannot use: Patient reported Weight from another setting Use of dash if no information is available Our assessment The next new question is height and weight. We collect this information today, however there is very specific guidance tied to this M item. First no decimal points are recorded. Use standard mathematical rounding with less than or equal to .4 rounds down and greater than or equal to .5 rounds up. They are look for consistency in weight just like we do in practice – using consistent scale and with shoes off. While not in the guidance manual, a recent Q&A also clarified we cannot use patient report nor a height and weight provided from another setting of service. The dash again is offered as an option and while they indicate should be rare, the community has voiced concerns this will be more frequent due to the reporting limitations. This metric however is important to have in our assessment, so we have made some modifications to allow for reporting of height and weight that is patient report or from the facility (for example) in the documentation area next to this M item. Height and weight should be documented on every patient at the time of assessment and ongoing as indicated by the clinical condition (see upcoming bulletin for more information). On an OASIS where this is documented will be based on the guidance here.

M1028 Active Diagnoses Here is a screenshot of this new question.

M1060 Height and Weight This slide displays how the question is displayed.

NEW GG0170C Mobility The next new question has some similarity to the OASIS questions today and has some differences. GG0170C measures the patients ability to move from a lying to sitting position on the side of the bed. It is assessed at SOC and ROC. But where did this question come from?

MDS MDS is used to assess patients in a SNF
Our nursing home partners have an assessment similar to the OASIS called the MDS or minimum data set. It is also completed at the beginning of care. For nursing homes, it is an entire set of questions, our assessment only has this one component. We are starting to see CMS wanting to obtain the same patient assessment across settings.

GG0170C Mobility Assessment Observation Safe
With or without assistive devices Performance varies The guidance in the OASIS manual is consistent with other functional items. The completion of the question should be based ideally on the observation of a task, record the most independent, but only if the patient is safe in performing the task. The patient may use an assistive devise as long as they are safe. And if the patient’s self-care performance varies during the assessment time frame, report the patient’s usual status, not the patient’s most independent status and not the patient’s most dependent status.

GG0170C Mobility Discharge goal Use 6 point scale
Do not use 07, 09 or 88 In collaboration with patient and caregiver Can be more or less independent Use of dash To report the discharge goal using the 6-point scale. Do not enter 07, 09, or 88 to report the discharge goal. The assessing clinician, in conjunction with patient and family input, can establish the discharge goal. Based on the collaboration with the patient and caregiver(s), the response reported for Discharge Goal will be higher (more independent) than the SOC/ROC Performance response or the same or even a decline based on the condition of the patient. If the assessing clinician does not establish a Discharge Goal for the patient’s bed mobility task, enter a dash (“–“) for 2-Discharge Goal. A dash ( –) value is a valid response for this item. A dash (–) value indicates that no information is available, and/or an item could not be assessed. This most often occurs when the patient is unexpectedly transferred, discharged or dies before assessment of the item could be completed. CMS expects dash use to be a rare occurrence.

GG0170C Response Options Enter 06 – Independent, if the patient completes the activity by him/herself with no human assistance Enter 05 – Setup or clean-up assistance, if the caregiver SETS UP or CLEANS UP; patient completes activity. Caregiver assists only prior to or following the activity, but not during the activity. For example, the patient requires assistance putting on a shoulder sling prior to the transfer, or requires assistance removing the bedding from off his/her lower body to get out of bed. Enter 04 – Supervision or touching assistance, if the caregiver must provide VERBAL CUES or TOUCHING/ STEADYING assistance as patient completes activity. Assistance may be required throughout the activity or intermittently. For example, the patient requires verbal cueing, coaxing, or general supervision for safety to complete activity; or patient may require only incidental help such as contact guard or steadying assist during the activity. Lets now review the responses, the responses on the slide are the same that are displayed on the question so we will summarize here, not read the entire response. The first thing you will notice the scale is reversed from the other OASIS items. 06 the first option is independent and the level of dependency increases as the number decrease. 05 indicates the patient requires some assistance either before or after the activity. 04 indicates some supervision with either verbal cues or touching.

GG0170C Response Options Enter 03 – Partial/moderate assistance, if the caregiver must provide LESS THAN HALF the effort. Caregiver lifts, holds, or supports trunk or limbs, but provides less than half the effort. Enter 02 – Substantial/maximal assistance, if the caregiver must provide MORE THAN HALF the effort. Caregiver lifts or holds trunk or limbs and provides more than half the effort. Enter 01 – Dependent, if the caregiver must provide ALL of the effort. Patient is unable to contribute any of the effort to complete the activity; or the assistance of two or more caregivers is required for the patient to complete the activity. Moving to more assistance 03 is partial and can be classified as less than half of the effort with response 02 representing more than half of the effort. Finally 01 is dependent on others.

GG0170C Response Options If the patient does not attempt the activity and a caregiver does not complete the activity for the patient, report the reason the activity was not attempted. Enter 07 – Patient refused, if the patient refused to complete the activity. Enter 09 – Not Applicable, if the patient did not perform this activity prior to the current illness, exacerbation, or injury. Code 88 – Not attempted due to medical condition or safety concerns, if the activity was not attempted due to medical condition or safety concerns. If no information is available or assessment is not possible for reason other than above, enter a dash (“–“) for 1-SOC/ROC Performance. Then there are three other options for the assessment portion of this question. 07 if the patient refuses, 09 if the patient did not perform this activity before this illness. And last is 88 meaning there is a medical or safety concern preventing the completion of this assessment item. And we have already discussed the use of a dash.

GG0170C Examples The patient pushes up from the bed to get himself from a lying to a seated position. The caregiver must provide steadying (touching) as the patient scoots himself to the edge of the bed and lowers his feet onto the floor. Lets look at a couple examples. Read slide. Answer: GG0170C1 – SOC/ROC Performance: ENTER 04 – Supervision or touching assistance • Rationale: The patient required steadying/touching assistance in order to safely complete the task of lying on his back to sitting on the side of the bed.

GG0170C Examples The patient pushes up on the bed to attempt to get himself from a lying to a seated position as the OT provides much of the lifting assistance necessary for him to sit upright. The OT provides assistance as the patient scoots himself to the edge of the bed and lowers his feet to the floor. Overall, the OT must provide more than half of the effort to complete the task. Read slide. Answer: GG0170C1 - SOC/ROC Performance: ENTER 02 – Substantial/maximal assistance • Rationale: The patient required the caregiver to provide lifting and assistance that represents more than half of the effort required to complete the task of lying on his back to sitting on the side of the bed.

GG0170C Examples The patient is obese and recovering from surgery for spinal stenosis with lower extremity weakness. The caregiver partially lifts the patient’s trunk to a fully upright sitting position on the bed and minimally lifts each leg toward the edge of the bed. The patient then scoots toward the edge of the bed, placing both feet flat onto the floor. The patient completes most of the activity himself. Read slide. Answer: GG0170C1 - SOC/ROC Performance: ENTER 03 – Partial/moderate assistance • Rationale: The patient required the caregiver to provide limited assistance that represents more than just verbal cues/touching/steadying, but less than half of the effort required to complete the task of lying on his back to sitting on the side of the bed.

GG0170C Examples The patient states he wishes he could get out of bed himself rather than depending on his wife to help. At the SOC the patient requires his wife to do most of the effort. Based on the patient’s prior functional status, his current diagnoses, the expected length of stay, and his motivation to improve, the clinician expects that by discharge, the patient would likely only require assistance helping his legs off the bed to complete the supine to sitting task. Read slide. Answer: GG0170C1 - SOC/ROC Performance: ENTER 02 – Substantial/maximal assistance • GG0170C2 - Discharge Goal: Enter 03 – Partial/moderate assistance • Rationale: At the SOC, the patient required the caregiver to provide more than half of the effort required to complete the task. The assessing clinician and patient expect functional improvement so that by discharge the patient needs a caregiver to assistant, providing less than half of the effort.

C2 Effective Date M0090 on or before 12/31/2016
OASIS C1-ICD10 M0090 on or after 1/1/2017 OASIS C2 Remember more than one day to complete assessment As with other assessment conversions, OASIS C2 begins at the beginning of 2017 and is based on the M0090 date. So any assessment with a M0090 date of 12/31/16 or before is OASIS C1-ICD10 and 1/1/17 or after is OASIS C2. They did not change the rules around allowing 5 days to complete an assessment so caution should be taken with recerts and SOC close to the 1/1/17 cut off. This does mean you may have a patient whose first OASIS assessment is a C1 version and will be continued or discharged with a C2 version.

KindredLink Similar to last year, there will be a pop up window that allows the clinician to select the appropriate OASIS version based. You will receive validation errors if the wrong assessment was selected based on the M0090 date .

Resources CMS website Instruments/OASIS/Training.html OASIS C-2 manual Q&A’s WOCN guidance There are a lot of resources for OASIS, external as well as our intranet. On the Kindred intranet… On the Gentiva intranet, see the OASIS page.

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