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Asked a question 8 months ago

I am aware of intent/coding instructions for assessment of the patient. My question is, the patient was not assessed due to a non-visit. I have not been able to find specific guidance on how to address cognitive questions. Would it be more appropriate to use "information not available" or whether the answers would be "no" since patient could not answer question (assessment not conducted).

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Axxess Implementation Consultant

Hi Lanessa, 

I am providing information below that should help, which was pulled directly from a OASIS E discharge guidance document. 

In the case of an unplanned discharge, CMS still requires the DC OASIS to be based on an assessment. There is no OASIS guidance that allows for a “non‐visit” discharge OASIS assessment. The discharge OASIS requires an in‐person patient encounter and assessment. Cat2‐Q15.3.9 Guidance for unplanned discharges allows for the OASIS to be completed by the last qualified clinician who last saw the patient based on their findings. These findings may be supplemented by information documented by other agency staff in visits occurring in the last 5 days that the patient received visits prior to the unexpected discharge. Last 5 days means date of the last patient visit plus the four preceding days.   There are several circumstances that may result in the absence or unavailability of the last qualified clinician (maternity leave, termination, etc.). Cat2-Q153.2 CMS recommends the following in this order: 1. Send another qualified clinician to complete the discharge. This should be the agency’s first choice but of course it is not always possible. The patient may not be cooperative or has disappeared. 2. If it is not possible for a qualified clinician to visit the patient, look back at the notes and find another qualified clinician who visited the patient to complete the DC OASIS based on their last visit. That assessing clinician can supplement their documentation with information documented by other agency staff in visits occurring in the last 5 days that the patient received visits prior to the unexpected discharge. 3. It may not be possible to complete a DC OASIS assessment. It is not appropriate for a supervisor, or other agency personnel who has never visited the patient to complete a DC OASIS using notes from other agency personnel. What is required when an assessment cannot be completed varies by software, but if there are too many instances of non‐completion of an OASIS, CMS can reduce your payment by 2% for non‐submission. There have been many questions regarding how to respond to the new OASIS E questions in the case of an unexpected discharge. To be compliant, the person completing the OASIS must have visited the patient. If a visit to complete an OASIS DC assessment cannot be made, the following recommendations are made based on current OASIS E guidance and clinical judgment. Agency personnel are encouraged to make their own decisions based on the official guidance and their own clinical judgment and circumstances. 

C0100‐C0500—BIMS C0100 can be answered based on information documented in the last visits. However, the actual BIMS (Brief Interview for Mental Status) item requires patient performance. Was there a BIMS used with the patient at the last visit? A dash indicates no information. Unless you can get the patient to respond to the screening, you will need to respond with dashes. C0500 will be scored with a dash.
C1310—CAM This item requires observation of the patient. It is not an interview item. Unless there is enough relevant information in the documentation from the last visits, this entire item will be dashed.
D0150‐D0160—Patient Mood Interview The PHQ2‐9 requires interview of the patient. If a patient interview is not possible, then dashes are appropriate in column 1. A dash is never appropriate in column 2. If the interview is not conducted, score D0160 as 99. A dash is not appropriate in D0160. 


I hope this helps! Please reach back out if needed.

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