OASIS Alert

Published on Wed Jun 04, 2014 PDF

Hint: Look to the OASIS Q&As when you’re stuck with this item.

It’s no secret that the integumentary items on the OASIS are some of the biggest head-scratchers a clinician can face. When it comes to reporting surgical wounds, your best strategy is to study up and know where to look for answers when you’re stumped.

OASIS item M1340 asks you to identify whether your patient has a surgical wound. That may seem like a straightforward question at first glance, but knowing what qualifies as a surgical wound under OASIS logic can stump even the most seasoned clinician.

Answer M1340 incorrectly, and with OASIS skip patterns, you may never get to the case mix item, M1342 — Status of the patient’s most problematic (observable) surgical wound. The result could be a negative impact on payment for the episode.

If you select M1340 response “2 — Surgical wound known but not observable due to non-removable dressing” the prompt is to skip M1342 — Status of most problematic (observable) surgical wound, says Thelma Bowen, MSN, RN, with HealthCare Compliance Services in San Antonio, Texas.

Waiting to assess the wound — even if it means returning to the patient’s home — increases the possibility of adding case mix points and improving the payment and the accuracy of the HHRG. M1342 Responses “2 — Early/partial granulation” and “3 – Not healing” both add case-mix points. “We don’t want to miss that,” Bowen says.

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.

Essential: Before you can select an answer for this item, you’ll need to understand the types of wounds the Centers for Medicare & Medicaid Services considers surgical wounds.

Several things related to reporting surgical wounds on the OASIS can almost seem counterintuitive to a clinician, says Pat Jump with Rice Lake, Wis.-based Acorn’s End Training & Consulting.

For example: A surgically implanted access device such as a port-a-cath is a surgical wound for as long as the device remains implanted — regardless of the condition of skin covering the site.

What is a Surgical Wound?

The section in the CMS OASIS Q&As dealing with what is and is not a surgical wound is one of the largest in this resource. While reading through the section will help you with specific wounds, some basic logic can also help guide your way:

Understand skin matters. Only wounds that go through the skin or integumentary system make the cut as OASIS surgical wounds. But not every wound that goes through the skin counts as surgical.

For example: Ostomies go through the skin, but they aren’t surgical wounds for OASIS purposes. Incision and drainage sites or surgical debridement don’t make the grade either — unless there is a drain inserted. And skin grafts aren’t surgical wounds in OASIS either.

Take note of treatments. Another confusing area for this item is figuring out how treatments impact a wound for reporting purposes. For example, a pressure ulcer that has been surgically debrided remains a pressure ulcer, Jump says. It does not become a surgical wound.

Watch for scars. Knowing when a surgical wound becomes a scar instead of a surgical wound is also important for OASIS accuracy. A primary surgical wound (closed with sutures, staples, or a chemical bonding agent) is a surgical wound until re-epithelialization has been present for about 30 days, unless it dehisces or becomes infected, Jump says. After 30 days, the wound becomes a scar and should not be included in M1340.

Know what’s unobservable. M1340 asks you to report observable surgical wounds. Consider a wound not observable for OASIS reporting purposes if it is covered by a dressing (or cast) which a physician order says cannot be removed, Jump says.

OASIS-C1: Once the transition to OASSI-C1 occurs, response “2” for M1340 will change to “Surgical wound known but not observable due to non-removable dressing/device” adding “device” to the response for consistency with other wound items. This item will also have a new skip pattern because item M1350 — Does this patient have a Skin Lesion or Open Wound? will be deleted at follow-up and DC.

Keep current. CMS continues to publish clarifications for this item. Be sure to keep up with the CMS OASIS Q&As so you don’t miss new information and changes. You’ll find all the current Q&As under OASIS Questions and Answers at www.oasisanswers.com/aboutoas_links.htm.