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January 2007

Updated Chapter 8 OASIS Implementation Manual

In June 2006, the Centers for Medicare and Medicaid Services (CMS) originally published a revised Chapter 8  and soon after discovered several errors. In November, CMS published the updated revision of Chapter 8 in the OASIS Implementation Manual.

A few of these corrections, though minor, could very well impact payments and patient outcomes. For example, look at MO670 (Bathing-the ability to wash entire body). The way clinicians answer this question could potentially cost an agency approximately $250/patient. Why? Response 2 guides the clinician to mark it this way if a patient needs the assistance of another person to get in the tub or shower. With the revision that CMS has made, coding response 0 or 1 only occurs when the patient’s ability to get in and out of the shower is “the only bathing task requiring human assistance”. According to this guidance, the clinician is focusing on the patient’s ability to bathe themselves rather than the ability to transfer, which has always been the intent of the question. Therefore, by responding with a 0 or 1, there are no functional service domain points,   whereas responses 2 through 5 would give you 8 points.

CMS gave us another important clarification to assess the number of observable surgical wounds (MO484). According to the guidance, “When a single surgical wound heals in a way that results in one (or more) areas of complete epithelialization with other area(s) of partial healing, each non-epithelialized opening is counted as a separate wound”. An example used in the manual is a vertical laparotomy incision which is epithelialized in some areas,  yet has an opening at the mid-point and another at the distal point that would count as two wounds.

And as most of us are already aware, the emergency departments can hold patients without admitting them for an indefinite period of time. As a result, when clinicians are responding to MO830 (Emergent care), agencies must be cautious when they are answering this question to make sure the patient truly was admitted--and not held in the emergency department--to avoid a hit with an avoidable hospitalization.

These are just a few of the changes to the OASIS user manual. For a complete crosswalk of the changes and revisions, click here.

Cyndi Rohret RN, BSN, CRNI, CHPN
Clinical Consultant, Briggs Corporation

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