OASIS Alert

Published on Sat May 28, 2011 PDF

Are you overlooking this common implanted device that could bring you more points?

Your agency earns clinical domain points for patients receiving intravenous therapy, infusion therapy, parenteral nutrition, or enteral nutrition. But if you don't know the quirks of answering M1030 correctly, you could be negatively impacting your bottom line.

Confusion: "I believe M1030 is the one of the most misunderstood areas of the OASIS," says Helen C. Woolf MSN, RNBC with Ascentia Home Care in Clearwater, Fla. "Nurses tend to glide right over it."

Nurses aren't sure how to answer M1030, Woolf says. For instance, if a patient goes to a physician's office for some type of infusion, there is confusion as to whether the correct M1030 response is "1" or "4."

OASIS item M1030 asks you to indicate the therapies your patient receives at home. OASIS expert, Ann Giles, RN, BSN, HCS-D, COS-C, director of ICD-9 coding & OASIS review services with Biloxi, Miss.-based PPS Plus Software offers some pointers for accurately answering this item.

Your response options for M1030 -- Therapies the patient receives at home are:

Crucial: This item looks at only therapies the patient receives at home, not those administered in outpatient facilities or elsewhere outside the home.

Tip: Your agency doesn't have to be administering the therapy for you to report it in M1030, Giles says. For example, if your patient has a PEG tube that his wife hooks up for night-time feedings, you can take credit for this by answering "3" for enteral nutrition because the therapy is taking place at home.

Caution: If the patient has a PRN order for IV therapy or enteral nutrition, but the guidelines for administration are not met on the day of the assessment, you should not consider these therapies at home, Giles says. However, if the patient will receive the therapy as a result of the assessment, or if you have orders to provide the therapy on a specific future date, you should mark it in M1030.

Response 1 refers to the administration of fluids via an IV line, subcutaneous infusion, insulin pump, epidural catheter, or intrathecal catheter, Giles says. Response 1 also applies to patients receiving hemodialysis or peritoneal dialysis in the home.

Don't miss: Take credit for your patient's insulin pump. Agencies often neglect to score "1" for this reason and miss out on potential points as a result.

Response 1 is appropriate when patients receive intermittent medications or fluids via an IV line. However, if the patient has an IV catheter that is not active, it's not appropriate to list "1."

Response 2 is the correct response to report when the patient is receiving TPN and/or lipids, Giles says.

Response 3 refers to administration of enteral nutrition via an NG tube, G-tube, J-tube or any other artificial entry into the GI tract, Giles says. Flushing a feeding tube, electrolyte maintenance solutions, such as Pedialyte, and medication administration alone, do not provide nutrition and therefore response "3" does not apply to these situations.

Response 4 should be marked if the patient is not receiving any of the above therapies, Giles says. You should also list "4" when your patient is receiving a listed therapy, but it is occurring outside the home.

M1030 Update: In the December 2010 updates to the OASIS users manual, the Centers for Medicare & Medicaid Services added an additional response-specific instruction for M1030. "An irrigation or infusion of the bladder is not included when completing M1030, Therapies at Home," CMS said.

M1030 should be an easy question to answer but like most OASIS items, it has a twist or two that make you stop and think, says Dee McCarraher, RN, HCS-D, COS-C, with Family Care Home Health in Richmond, Va.

Tip #1: Look at the big picture. Think first of all the therapies your patient is getting and determine whether they meet one of the therapy types listed in responses 1, 2, or 3, McCarraher says. For example, subcutaneous injections don't count for this question. But, when your patient says he is receiving hemo dialysis, don't assume he goes to a center for it. More patients are doing hemodialysis at home, McCarraher says, and you can take credit for these patients with Response 1. And patients new to peritoneal dialysis may go to a dialysis center for a week for intensive education, but return home and still qualify for Response 1.

Tip #2: Take credit for all appropriate therapies in the home. For any therapy to count at M1030 it must be received at home, McCarraher says. But clinicians often neglect to take credit for insulin pumps because they do not have direct responsibility related to them, she says. M1030 asks whether the therapies take place at home -- not about who is responsible for conducting the therapy. And don't discount less complex therapies. McCarraher says. Eclipse bulb infusion, infusion by gravity, or infusion by CADD pump all count as infusion. There are no parameters that limit you to reporting only high tech therapies at M1030.

Tip #3: Take credit for new orders. Don't neglect to take credit if the patient will receive the therapy as a result of your assessment that day, McCarraher says. For example, your assessment determines that the patient hasn't eaten in five days. He has an unused PEG tube. You contact the physician and get orders to start tube feeding. You can take credit for this enteral nutrition therapy with Response 3.

Tip # 4: Don't put off answering M1030. Waiting to select OASIS responses until after you've left the home can decrease your accuracy, Wolff says. If you're completing the OASIS after you've gone back to your office or home, "you have forgotten important bits of information, such as whether the patient has a feeding tube and is getting bolus along with eating food," she says. Answering all the questions in order and while you are in the patient's home is the easiest way to capture all the different attributes of the assessment, she says.

Think you've mastered this question? Test your M1030 skills with the quiz on page 52.