Medicare Compliance & Reimbursement

How accurate are HHAs' OASIS wound care answers?

Heads up, home health agencies: OASIS wound care coding is the next hot spot on the feds' list.
 
A staggering 111 points in the clinical severity domain are at stake in OASIS items M0440 (wounds/lesions), M0450 (multiple pressure ulcers), M0460 (most problematic pressure ulcer stage), M0476 (stasis ulcer status) and M0488 (surgical wound status).
 
And it takes only 41 points to boost a patient to the highest clinical domain score, C3 in the home health resource group. An increase from C0 (0 to 7 points) to C3 can make a difference of $1,500 in some of the prospective payment system payment categories.

Accordingly, the Centers for Medicare & Medicaid Services is offering an Internet and satellite training session on wound care April 23 from 1 p.m. to 3:30 p.m. Home health agencies also can watch the archived Internet broadcast for up to one year, but then they'll miss out on the live question-and-answer session.

In addition to accurate coding for OASIS wound care items M0440 through M0488, presenters from CMS, its OASIS contractor (the Center for Health Services and Policy Research) and Emory University will present on the "current state of science in wound care" and required OASIS assessments between days 55 and 60 of the PPS episode.

HHAs may hope to see CMS clarify when a wound is non-healing and therefore no longer qualifies for skilled care, observers say. CMS also is likely to address common wound care problems -- how to stage a pressure ulcer, surgical wound healing and differences between a pressure ulcer and a stasis ulcer.

Agencies tempted to skip the session may want to think again, since surveyors and state regulators will be watching. "This program will be mandatory for Regional Office and State Agency HHA survey staff and their supervisors, and State and RO OASIS Educational Coordinators," CMS spells out in its notice.

The session appears to be chock full of wound care and OASIS information, with seven handouts available for download before it begins. The OASIS tips in the handouts include:

Chemical or instrumental debridement does not make an ulcer a surgical wound (M0445-M0464).
Surgical wounds DO include pin sites, central lines, implanted infusion devices or venous access devices (M0482-M0488).
Surgical wounds DO NOT include peripheral IV sites or healed surgical wounds (scars).

Editor's Note: Information on the program is at www.cms.hhs.gov/oasis/hhtrain.asp.