M1030 reports which types of therapies the patient is receiving at home. In order to correctly answer this M item, a few general guidelines should be considered. Watch this video blog by Ann Giles, RN, BSN, HCS-D, COS-C to get a lesson on these guidelines.

The general rule for coding a post-op wound infection is to use 998.59 and 998.31 or 998.32 for post-op wound disruption. But as is the case with most rules, there are exceptions. Watch this video blog by Jennifer Warfield, RN, BSN, HCS-D, COS-C to get a better understanding of complicated surgical wounds.

M0110 is one of the most important items on the OASIS. Watch this video blog by Ann Giles, RN, BSN, HCS-D, COS-C to understand the key points and terms you should know for accurately answering this M item. 

Note: Click here for CMS' Table 4 mentioned in this video blog.

As PPS Plus Software's education director, I often speak to agencies that are frustrated with the decrease in their average case mix weight since the implementation of OASIS-C. So why is this a problem? Well, a decrease in case mix weight is ultimately going to result in a decrease in reimbursement. And loss of reimbursement in conjunction with recent proposed Medicare cuts can have a severe impact on an agency's financial status.

Agencies can take these proactive measures to ensure OASIS accuracy which will then result in financial accuracy:

1.) Implement in-depth and ongoing training for field and office staff on OASIS-C, as CMS frequently gives us new guidance or clarifications

2.) Develop a QA/PI program that includes software that allows you to check for coding or OASIS errors and/or inconsistencies

Training is the easy part. Assuring coding and OASIS accuracy can be a bit more challenging unless you have dedicated staff that will review EVERY OASIS with a fine-toothed comb. Finding the expert staff to do this job is hard enough, not to mention the time involved to accomplish this effectively (as we all know, gathering all of the needed information and making all the necessary changes to just one OASIS can take up valuable man hours).

That's why I (and everyone else here at PPS Plus Software) was so pleased to be informed that the proof of our software's effectiveness is in the pudding (or should I say ‘in the program'?) according to a recent article featured in DecisionHealth's weekly publication, Home Health Line.

In the article, Sharon Snider, director of Nason Hospital Home Health Agency in Roaring Spring, Pa., credits PPS Plus Software's Home Health Edition for helping to not only increase her agency's average case mix weight, but also her agency's revenue by an average of $900 per patient (while also dramatically decreasing the average time her staff previously spent reviewing the OASIS)!

Click here to read the article.

Home Health Line is the nation's leading independent authority on home health care business, regulation and reimbursement. Click here to subscribe to Home Health Line.

Let's continue the wound discussion by focusing on arterial ulcers. These wounds will be found in patients with arterial disease. Because of the partial/total occlusions or calcification of the arteries, circulation to the extremities is impaired.

These patients have very unique characteristics.
* Their legs will be thin, pale and shiny.
* Due to the lack of perfusion to the hair follicles, their legs will also be hairless.
* They will usually have thick toenails which are susceptible to fungal infections.
* These patients also suffer from dependent rubor (extreme redness when in a dependent position) and elevation pallor (paleness when the extremity is raised).

Lack of perfusion can become so severe at times, it causes an arterial ulcer. Characteristics of arterial ulcers are pretty standard.
* They are sharp-edged, full-thickness wounds which often times have tendons or bone visible.
* Because of the lack of blood flow, necrotic tissue is a common occurrence with these wounds.
* These wounds will be dry and have very little exudate.
* They are also painful and are prone to infection.
* The most distinguishing characteristic of these wounds is their location. They will be located in "end of the line" locations, such as the toes. This is because the further away the body part is from the heart, the more diseased vessels the blood has to flow through to feed the tissue, increasing the risk of ulceration.

Now that the arterial ulcer has been correctly identified, let's talk treatment. The wounds have a poor prognosis of healing. Greater means such as surgical intervention for revascularization or hyperbaric treatments are needed for healing. As a home health nurse, your focus should be on pain control and infection prevention.

All of us in home health knew that there would be some changes regarding our outcomes data, the addition of process measures and the Home Health Compare (HHC) data once OASIS-C began in January. We also knew there was still much to learn and many questions to be answered about the new process measures on OASIS-C. But did any of us think that we would have to face most of these changes and find the answers for ourselves? Probably not.

CMS announced several months ago that we would have a "blackout" period for OBQI data until next year and that we would not see the results of the data collected for the process measures from OASIS-C until late fall of 2010. Since then, I have heard quite a few people release a sigh of relief that they wouldn't have to worry about these things for at least 9 months. Absolutely not true.

Collection of data for the new process measures on OASIS-C and updated data for outcomes and potentially avoidable events began on January 1, 2010 with the implementation of OASIS-C. This month the Casper Report and HHC will be updated for the last time until there has been a sufficient amount of data collected to report accurate and useful results since the data from OASIS-C cannot be compared to data from OASIS-B1. The delay in reporting data after April only means that you will not have access to the quarterly data as you did prior to January 1. But any new data will be collected, compiled and reported starting this fall. The process measure data will be reported in September 2010 and the results from the outcome data will be reported in May of 2011.

Owners, directors, QI/PI and staff clinicians are still responsible for monitoring, collecting and deciding how to improve patient and agency outcomes during this "blackout" period. Remember, this data, even during the time you won't be able to access it, will still be publically reported.