The Patient-Driven Grouping Model (PDGM) is almost one week underway! In order to assist with the transition to PDGM, CMS has updated OASIS data collection. These revisions include the addition of two new items and change twenty-three existing items as optional at some OASIS time points. Let’s breakdown the changes.
Who
CMS has implemented changes to OASIS data collection as outlined in the CY 2019 Home Health Final Rule, CMS 1689-FC.
What
Two new OASIS items are now included during Follow-Up OASIS time points. Additionally, CMS made twenty-three existing OASIS items to be optional at certain time points. Here’s the breakdown.
- REQUIRED Follow-Up:
- M1033 Risk of Hospitalization
- M1800 Grooming
- OPTIONAL Start of Care/Resumption of Care (SOC/ROC):
- M1910 Fall risk Assessment
- OPTIONAL Transfer (TRN) and Discharge (DC):
- M2401a Intervention Synopsis: Diabetic Foot Care
- M1051 Pneumococcal Vaccine
- M1056 Reason Pneumococcal Vaccine not received
- OPTIONAL Follow-Up (FU):
- M1021 Primary Diagnosis
- M1023 Other Diagnoses
- M1030 Therapies
- M1200 Vision
- M1242 Frequency of Pain Interfering with Activity
- M1311 Current Number of Unhealed Pressure Ulcers at Each Stage
- M1322 Current Number of Stage 1 Pressure Injuries
- M1324 Stage of Most Problematic Unhealed Pressure Ulcer that is Stageable
- M1330 Does this patient have a Stasis Ulcer
- M1332 Current Number of Stasis Ulcers that are Observable
- M1334 Status of Most Problematic Stasis Ulcer that is Observable
- M1340 Does this patient have a Surgical Wound
- M1342 Status of the Most Problematic Surgical Wound that is Observable
- M1400 Short of Breath
- M1610 Urinary Incontinence or Urinary Catheter Presence
- M1620 Bowel Incontinence Frequency
- M1630 Ostomy for Bowel Elimination
- M2030 Management of Injectable Medications
- M2200 Therapy Need
When
January 1, 2020. This update will include Recertification assessments that occur 12/27/19-12/31/19 with payment episodes that begin January 1, 2020 or later.
Why
CMS has implemented this update to support the transition to the Patient Driven Groupings Model (PDGM). M1033 Risk of Hospitalization and M1800 Grooming are necessary items to calculate the case mix grouping. Additionally, the twenty-three items now optional items are not required in the case mix calculation under PDGM.
What isn’t changing?
The OASIS-D Guidance manual. This gives specific instructions to ensure accurate coding and will continue to serve as guidance for OASIS coding along with the CMS OASIS-D1 Update Document.