OASIS Alert

Published on Fri Aug 04, 2006 PDF

Up to $900 per episode may depend on it.

Clinicians who rely on feeling a healing ridge when answering M0488 may be getting the answer wrong.

Deadline: As of July 27, home health agencies must change the way they decide on the answer to OASIS item M0488 (Status of most problematic [observable] surgical wound). The answer to this question can add from seven to 15 points--and from $200 to $900 dollars--to a patient's episode payment.

M0488 also determines whether an agency shows improvement in the status of surgical wounds between OASIS assessment time points.

But if you can't define the stages of wound healing, you can't answer M0488 correctly, experts agree. And now the definitions have changed.

Break Old Habits Quickly To Protect Reimbursement

Old way: For five years, the Centers for Medicare & Medicaid Services told agencies to rely on the Spring 2001 "WOCN Guidance on OASIS Skin and Wound Status M0 Items," put together by the Laguna Beach, CA-based Wound Ostomy and Continence Nurses Society, at CMS' request. This guidance used the presence or absence of a "healing ridge" as a way to determine the healing stage of a surgical wound.

The healing ridge is a collagen deposit that "feels like a piece of cardboard stuck into the wound," explains wound care consultant Patti Johnston with Woodlands, TX-based Healthcare Quality Solutions.

New way: Effective July 27, CMS has instituted a "policy change for the accurate coding of surgical wounds," the agency announced on its OASIS Web site. CMS refers clinicians to the July revision of the WOCN Guidance, which was changed "based on current advances in wound care research," the feds say.

In the revised document the WOCN removed all references to the healing ridge from the definitions of surgical wounds healing by primary intention. "Clinical palpation of a healing ridge is not conclusive and should not be utilized to determine the status of a surgical wound," CMS instructs.

WOCN Announces New Descriptions Of Wound Healing Status

Be sure your clinicians have these three new definitions at their fingertips:

Fully granulating/healing:

• incision well-approximated with complete epithelialization of incision
• no sign or symptoms of infection

Early/partial granulation:

• incision well-approximated but not completely epithelialized
• no signs or symptoms of infection

Not healing:

• incisional separation OR
• incisional necrosis OR
• signs or symptoms of infection

Note: CMS' announcement is at www.cms.hhs.gov/HomeHealthQualityInits/14_HHQIOASISUserManual.asp. The revised WOCN guidance is at www.wocn.org/education/pdf/ WOCNOASISguidanceRev072406.pdf.