OASIS C2
Objectives
• Identify changes to the OASIS question
format and minor wording changes
• Identify changes to guidance
• Outline new questions and guidance
associated with completion
Minor Wording Changes
• Old: Since the previous OASIS
• New: Since the most recent SOC/ROC
assessment
OASIS C1-ICD10
OASIS C2
M1500
M1501
M1510
M1511
M2004
M2005
M2015
M2016
M2300
M2301
M2400
M2401
• Align with quality episode
Minor Wording Changes
Longer
Lookback
Period
Format changes
• Enter code box
– No change to content
– Many questions throughout assessment
– Aligns OASIS format with MDS used in SNF
July 20 2016 Q&A
Question 2: We utilize an electronic medical record. Do the formatting changes added to OASIS-C2
regarding the single box entry need to be presented to the clinicians in the EMR? The end result in the extract
is the same. Currently the response options are presented to the clinicians in a list with radio buttons to
indication response selection. Is this acceptable?
Answer 2: In the development and maintenance of OASIS-C2 Assessment user tools, Vendors are advised
to reference the Data Specifications v2.20.0 (http://www.cms.gov/Medicare/Quality-Initiatives- PatientAssessment-Instruments/OASIS/DataSpecifications.html). While the Data Specifications dictate the
Assessment Instrument Items, their applicable time point(s) in the Assessment Instrument, the exact
language of the Items, and each Item’s allowable response options, the Data Specifications do not dictate the
format of the graphical user interface (GUI) software presentation of the Items in the Assessment Instrument.
Per your example, presenting the allowable response options in the format of radio buttons in the GUI
software is acceptable, and is left to the user’s discretion, as long as such modification does not impact the
accuracy of the item scoring.
Format change example
OASIS C-1
OASIS C2
Kindred Link
Drug Regimen Review
Did a complete drug regimen review identify
potential clinically significant medication issues?
Drug Regimen Review
• Renumbering also M2005 (M2004) and M2016
(M2015)
Medication Reconciliation
Clarified timing of response from MD as midnight of
the next calendar day
•
Includes completion of recommended actions
OASIS C1-ICD10
OASIS C2
M2002
M2003
M2004
M2005
Medication Reconciliation
Clarification of Timing
Medication Reconciliation
Change in wording to indicate HHA completed recommended
actions given by physician
Medication Reconciliation
Clarification in wording indicates that medication
reconciliation is expected EACH time clinically significant
issues are found – Not just at OASIS time points
Dash in Medication Questions
• M2001 Medication Regimen Review
and M2003 Medication Follow up
• Dash allowed
– No information available
– Item cannot be assessed
– Rare occurrence
Wound Status
• All pressure ulcer questions
• Now use of Arabic numbers versus Roman Numerals
Roman Numerals
Standard
Stage I
Stage 1
Stage II
Stage 2
Stage III
Stage 3
Stage IV
Stage 4
Pressure Ulcers
• Do not reverse stage a pressure ulcer.
Consider the ulcer at its worst until healed.
• All pressure ulcers can heal
– Stage 1 no longer red/non-blanchable
– Stage 2,3,4 completely covered in epithelial
tissue
– Once healed the wound is no longer reported
as a pressure ulcer
• Previously healed stage 3 or 4 that reopens
at the same site is reported at its worst
previous stage
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Pressure Ulcers
• Assessing clinician may report a pressure ulcer
and stage without physician confirmation per
OASIS guidance
– Coding conventions require confirmation
• Pressure ulcer covered with slough/eschar is
not stageable but is observable to assess
healing status
• A pressure ulcer that has been debrided is still
a pressure ulcer
• A pressure ulcer that is treated with a muscle
flap or skin graft becomes a surgical wound
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Pressure Ulcers
• If any bone, tendon or muscle or joint
capsule (Stage 4 structures) is visible,
the pressure ulcer should be reported
as a Stage 4 pressure ulcer, regardless
of the presence or absence of slough
and/or eschar in the wound bed.
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M1306 Unhealed Pressure
Ulcer
Healed = Closed
Unhealed = Open
Do not change assessment for an ulcer that
increases in numerical stage within the
assessment time period (5 day window)
M1307 Oldest stage 2
• Enter Response 1 only if the oldest Stage 2 pressure ulcer
that is present at discharge was already present as a Stage 2
pressure ulcer when first assessed at the SOC/ROC.
• Enter Response 2 if the oldest Stage 2 pressure ulcer that is
present at discharge was NOT a Stage 2 pressure ulcer at the
most recent SOC/ROC. Then, enter the date that it was
identified as a Stage 2.
• Do not consider suspected Stage 2 wounds that are currently
not observable
Wound Status
Answer at SOC, ROC, Recert, DC
Remember M1308 from OASIS C?
M1311 Current Number
• If the pressure ulcer was unstageable at
SOC/ROC, but becomes numerically stageable
later, when completing the Discharge assessment,
its “Present on Admission” stage should be
considered the stage at which it first becomes
numerically stageable. If it subsequently increases
in numerical stage, do not report the higher stage
ulcer as being “present at SOC/ROC” when
completing the Discharge assessment.
• If a pressure ulcer that is identified on the SOC
date increases in numerical stage (worsens) within
the assessment time frame, the initial stage of the
pressure ulcer would be reported in M1311 at the
SOC
M1311 Current Number
• Multiple responses for unstagable
• Non-removable dressing: Ulcer must be
‘known’ to be present in order to be counted
M1313 Worsening in Pressure
Ulcer Status Since SOC/ROC
• Question wording:
– OASIS C1-ICD10 – M1309 Instructions for a
– c: For Stage II, III and IV pressure ulcers,
report the number that are new or have
increased in numerical stage since the most
recent SOC/ROC
– OASIS C2 – M1313 Instructions for a-c:
Indicate the number of current pressure ulcers
that were not present or were at a lesser
stage at the most recent SOC/ROC. If no
current pressure ulcer at a given stage, enter
0.
M1313
Notice there
are now 3
options for
unstageable
ulcers
M1313 Worsening in Pressure Ulcer
• Locate all current Stage 2, 3, 4 and unstageable
pressure ulcers.
• Review the history of each current pressure ulcer and
compare the current stage to the stage of the ulcer at
SOC/ROC.
• Follow the algorithm to determine if the wound is
reportable as new or worsened.
M1313 – Algorithm
M1313 Worsening in Pressure Ulcer
• Dash is available as response
– No information available
– Item could not be assessed
– Possibly when a patient is unexpectedly
transferred, discharged or dies before
assessment could be completed
– Rare occurrence
M1340 Surgical Wound
• If a pressure ulcer is surgically closed with a
flap or graft it is no longer reported as a
pressure ulcer. It should be reported as a
surgical wound until healed. If the flap or graft
fails, it should continue to be considered a
surgical wound until healed.
Other Guidance Changes
M0090 Date Assessment Completed
• If the clinician needs to follow-up, off site, with the patient’s
family or physician in order to complete an OASIS or nonOASIS portion of the comprehensive assessment, M0090
should reflect the date that last needed information is
collected.
• If the original assessing clinician gathers additional
information during the SOC 5-day assessment time frame that
would change a data item response, the M0090 date would
be changed to reflect the date the information was gathered
and the response change was made.
M1017 Diagnoses Requiring
Treatment
• A diagnosis reported in M1011 – Inpatient
Diagnosis may also be reported in M1017 if within
the 14 days prior to the SOC/ROC date the
condition was
– new or exacerbated,
– required changes in the treatment regimen
– AND the patient was discharged from an inpatient
facility where the condition was actively treated.
M1046 Influenza Vaccine
• Response 8 includes when assessing clinician is
unable to determine whether the patient received
the influenza vaccination.
Day Counting
• Last 14 days at discharge
– Use M0090
• M0090 date is day 0 and the day
immediately prior to M0090 date is day 1
• OASIS items
– M1600
– M1710
– M1720
M1740 Cognitive Symptoms
• Behaviors reported could be identified by a
formal diagnosis and/or determined by the
assessing clinician to be associated with a
significant neurological, developmental,
behavioral and/or psychiatric disorder.
M1840 Toilet Transferring
• In the absence of a toilet in the home, the assessing clinician
would need to determine if the patient is able to use a bedside
commode (Response 2), or if unable to use a bedside
commode, if he is able to use a bedpan/urinal independently
(Response 3). If the patient is not able to use the bedside
commode or bedpan/urinal as defined in the responses
• If such equipment is not present in the home to allow
assessment, then Response 4 – totally dependent in
toileting would be appropriate.
New Questions
• M1028 – Active Diagnoses –
Comorbidities – Co-existing Conditions
– Peripheral vascular disease (PVD) and
Peripheral artery disease (PAD)
– ICD10 code categories
» I70 - fourth digit of 2, 3, 4, 5, 6, 7, 9,
» I73
– Diabetes
• ICD10 code categories E08, E09, E10, E11,
E13
NEW
M1028 Active Diagnoses
• Physician (or other allowed party)
confirmed
• Direct relationship
– To the patient’s current functional,
cognitive, mood or behavior status;
medical treatments; nurse monitoring; or
risk of death at the time of assessment
• Do not include resolved diagnoses
• Use of dash
New Questions
• M1060 – Height and Weight
– Standard mathematical rounding
• < .4 – round down
• > .5 – round up
– In accordance with company policy and
standard of practice
– Cannot use:
• Patient reported
• Weight from another setting
– Use of dash if no information is available
– Our assessment
M1028 Active Diagnoses
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M1060 Height and Weight
NEW
GG0170C Mobility
MDS
MDS is used to assess patients in a SNF
GG0170C Mobility
• Assessment
– Observation
– Safe
– With or without assistive devices
– Performance varies
45
GG0170C Mobility
• Discharge goal
– Use 6 point scale
– Do not use 07, 09 or 88
– In collaboration with patient and caregiver
– Can be more or less independent
– Use of dash
46
GG0170C Response Options
•
Enter 06 – Independent, if the patient completes the activity by him/herself with no human
assistance
•
Enter 05 – Setup or clean-up assistance, if the caregiver SETS UP or CLEANS UP;
patient completes activity. Caregiver assists only prior to or following the activity, but not
during the activity. For example, the patient requires assistance putting on a shoulder sling
prior to the transfer, or requires assistance removing the bedding from off his/her lower
body to get out of bed.
•
Enter 04 – Supervision or touching assistance, if the caregiver must provide VERBAL
CUES or TOUCHING/ STEADYING assistance as patient completes activity. Assistance
may be required throughout the activity or intermittently. For example, the patient requires
verbal cueing, coaxing, or general supervision for safety to complete activity; or patient
may require only incidental help such as contact guard or steadying assist during the
activity.
GG0170C Response Options
• Enter 03 – Partial/moderate assistance, if the caregiver must
provide LESS THAN HALF the effort. Caregiver lifts, holds, or
supports trunk or limbs, but provides less than half the effort.
• Enter 02 – Substantial/maximal assistance, if the caregiver
must provide MORE THAN HALF the effort. Caregiver lifts or
holds trunk or limbs and provides more than half the effort.
• Enter 01 – Dependent, if the caregiver must provide ALL of the
effort. Patient is unable to contribute any of the effort to
complete the activity; or the assistance of two or more
caregivers is required for the patient to complete the activity.
GG0170C Response Options
• If the patient does not attempt the activity and a
caregiver does not complete the activity for the
patient, report the reason the activity was not
attempted.
– Enter 07 – Patient refused, if the patient refused to complete the
activity.
– Enter 09 – Not Applicable, if the patient did not perform this activity
prior to the current illness, exacerbation, or injury.
• Code 88 – Not attempted due to medical condition or
safety concerns, if the activity was not attempted due to
medical condition or safety concerns.
• If no information is available or assessment is not possible
for reason other than above, enter a dash (“–“) for 1SOC/ROC Performance.
GG0170C Examples
• The patient pushes up from the bed to
get himself from a lying to a seated
position. The caregiver must provide
steadying (touching) as the patient
scoots himself to the edge of the bed
and lowers his feet onto the floor.
GG0170C Examples
• The patient pushes up on the bed to
attempt to get himself from a lying to a
seated position as the OT provides much
of the lifting assistance necessary for him
to sit upright. The OT provides assistance
as the patient scoots himself to the edge of
the bed and lowers his feet to the floor.
Overall, the OT must provide more than
half of the effort to complete the task.
GG0170C Examples
• The patient is obese and recovering from
surgery for spinal stenosis with lower
extremity weakness. The caregiver
partially lifts the patient’s trunk to a fully
upright sitting position on the bed and
minimally lifts each leg toward the edge of
the bed. The patient then scoots toward
the edge of the bed, placing both feet flat
onto the floor. The patient completes most
of the activity himself.
GG0170C Examples
• The patient states he wishes he could get
out of bed himself rather than depending
on his wife to help. At the SOC the patient
requires his wife to do most of the effort.
Based on the patient’s prior functional
status, his current diagnoses, the expected
length of stay, and his motivation to
improve, the clinician expects that by
discharge, the patient would likely only
require assistance helping his legs off the
bed to complete the supine to sitting task.
C2 Effective Date
• M0090 on or before 12/31/2016
– OASIS C1-ICD10
• M0090 on or after 1/1/2017
– OASIS C2
– Remember more than one day to complete
assessment
KindredLink
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Resources
• CMS website
http://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/OASIS/Training.html
• OASIS C-2 manual
• Q&A’s
• WOCN guidance
Questions