OASIS Alert

Published on Thu Sep 27, 2012 PDF

Warning: You can't rely on clinical reasoning and logic for this item.

The OASIS wound items are some of the most confusing to answer, but getting them right is essential. For an accurate accounting of your patient's condition as well as correct reimbursement, it's vital you know your way around these tricky questions.

OASIS item M1340 asks you to identify whether the patient has a surgical wound. And if you don't answer correctly, you may never get to the case mix item, M1342 -- Status of the patient's most problematic (observable) surgical wound which can add payment to the episode home health resource group (HHRG), points out Judy Adams, RN, BSN, HCS-D, HCS-O with Adams Home Care Consulting in Chapel Hill, N.C.

Establish the Basics

Your response options for M1340 -- Does this patient have a surgical wound? are:

0 -- No;

1 -- Yes, patient has at least one (observable) surgical wound; and

2 -- Surgical wound known but not observable due to non-removable dressing.

The purpose of this item is to identify the presence of any wound resulting from a surgical procedure.

Complete M1340 at start of care, resumption of care, follow-up, and discharge from agency -- not to an inpatient facility.

Key: Before you can select an answer for this item, you'll need to study up on what exactly the Centers for Medicare & Medicaid Services considers a surgical wound.

"M1340 is one of those items where our clinical knowledge and professional sense isn't enough to select a correct answer," says Rhonda Will, RN, BS, COS-C, HCS-D, with Northampton, Mass.-based Fazzi Associates. This seemingly simple question is very intricate with all that it includes and excludes, she says. "CMS has placed boundaries on the simple definition found in the OASIS-C Manual's item intent, 'presence of any wound resulting from a surgical procedure.'"

What is a Surgical Wound?

"There are probably more CMS Q&As about what is and is not a surgical wound than nearly any other OASIS item," Adams says. In OASIS, only wounds that go through the skin or integumentary system count as surgical wounds.

Don't include: Wounds as a result of surgery on the eyes or through the vagina, or any other mucous membrane, do not count as surgical wounds for this item, Adams says.

Avoid Clinical Logic Trip-Ups

Although only wounds that go through the skin or integumentary system count as surgical wounds on the OASIS, not every wound that goes through the skin makes the cut.

Certain types of wounds that go through the skin -- such as ostomies -- aren't surgical wounds for OASIS purposes, Adams points out. And neither are incision and drainage sites or surgical debridement -- unless there is a drain inserted. Skin grafts don't rate as surgical wounds either.

However, CMS has expanded the definition of a surgical wound to include:

• Central line sites;
• Medi-port and portacath sites;
• Other sites for implanted infusion devices;
• Venous access devices; and
• Arteriovenous shunts and peritoneal dialysis catheter exit sites

as long as they are in place, regardless of functionality or frequency of use, Will says.

"Most clinicians don't think of vascular access sites as surgical wounds," Will says. Adding to that confusion is the exclusion of PICC line sites and peripheral IV sites as surgical wounds.

"Clinicians tend to think of PICC lines in the same grouping as central lines but that is not the way in M1340," Will explains.

Once you've mastered these instructions, watch for another curveball with implanted infusion devices and ports. These wounds do qualify as surgical wounds as long as they are in place, but the incision to insert an ventriculoperitoneal shunt is a surgical wound only until the implantation site heals and it becomes a scar, Will says.

What about a pacemaker? A pacemaker or defibrillator is an implanted device, not an implanted infusion device, and is not a surgical wound as long as the device is in place, Will says. "The implanted cardiac device is a surgical wound only until the incision site heals to the point of a scar."

CMS continues to publish clarifications for this item. Be sure to keep up with the OASIS Q&As so you don't miss new information and changes. You'll find all the current Q&As here: https://www.qtso.com/hhadownload.html.

Note: For more on what CMS considers a scar for M1340, see the sidebar on page 123. And see the chart below for a breakdown of what is and is not considered a surgical wound for this item.