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ast month in this column, we began our discussion of Outcome and Assessment Information Set (OASIS) questions on cognitive ability and altered mental status, covering M0560 through M0610. Let us continue with M620.

(M0620) Frequency of Behavior Problems (Reported or Observed) (eg, wandering episodes, self abuse, verbal disruption, physical aggression, etc.):
0 - Never
1 - Less than once a month
2 - Once a month
3 - Several times each month
4 - Several times a week
5 - At least daily

       Question M0620 is a continuation of M0610 and is needed to determine how often these behaviors occur. These behaviors are common in patients with dementia and psychotic disorders and can therefore help us identify patients who need a more focused psychological evaluation and treatment plan. Anyone who displays any of these behaviors more than once a month could benefit from a psychological evaluation.

(M0630) Is this patient receiving Psychiatric Nursing Services at home provided by a qualified psychiatric nurse?
0 - No
1 - Yes

       The final question related to mental and neurological status is M0630, which asks if the patient is receiving psychiatric services.
       As a point of reference, let us review how these OASIS questions were answered on all patients. The data source in Table 1 is the Case Mix Profile Report available to every

Table 1

certified home healthcare agency for the first quarter (Q1) of 2005. The sample size was 1.1 million patients.
       As we have reviewed in this article, completing the Neuro/Emotional/ Behavioral section of OASIS requires clinicians to assess a patient’s cognitive function and mental status in a systematic way. But it is important to remember that this screening should not replace thorough psychiatric evaluations and diagnoses in patients with significant impairment. Instead, it should identify symptoms and help guide referrals for these patients, to help provide the best care possible for each patient.

Questions and Answers

       Question: If a patient has experienced episodes of recent confusion but does not demonstrate or report any episodes of confusion today (the date of the assessment), would the patient be considered “never” confused? Or should the recent history of confusion be considered when responding to M0570?
       Answer: Information collected from patient or caregiver reports can be used in responding to M0570. This includes reports that extend beyond the day of the assessment. Therefore, if the patient or his or her family reported that the patient has experienced periods of confusion on awakening a few mornings over the last week, it would be appropriate to mark “2” on “awakening” or “at night only” for M0570, even if no confusion was experienced today. This same strategy of using reported information from the recent past also applies to the scoring of anxiety in M0580 and depressive feelings in M0590.
       Question: Are the behaviors to be considered in responding to M0620 limited to only those listed in M0610?
       Answer: No, there are behaviors other than those listed in M0610 that can be indications of alterations in a patient’s cognitive or neuro/emotional status. Other behaviors, such as wandering, can interfere with the patient’s ability to reach his or her optimal level of functioning, and the frequency of these should be considered in responding to the item.
       Earlier in the OASIS assessment, the clinician is asked to assess the patient’s prognosis, rehabilitative status, and risk factors. These questions can be difficult for the clinician to answer. The first of these is M0260, Overall Prognosis. The key in answering this question is relating the patient’s likelihood of recovery from this episode of illness in relation to the care being provided in the home. Be sure to take comorbities into consideration, as they clearly can impact the patient. For example, if the reason a fracture occurred is related to bone cancer, the prognosis may be poor. Choices are limited with this question to poor and fair/good.
       Question M0270, Rehabilitation Prognosis, continues the prognosis evaluation. To properly answer this question, use the data gathered during the assessment regarding the patient’s functional status and past history. How likely is the patient to have an improvement in his or her functional status during this episode of care? The referring physician can also provide useful information to complete this question.
       Question M0280, Life Expectancy, is one of the more difficult questions for the clinician to answer, since determining how long someone has left to live is complicated. This question asks the clinician to make a determination on whether the patient will live longer than 6 months. As with other OASIS questions, it is vital to interview, review history and all diagnoses, and consult with the family to make an estimation for this question. It is not necessary to have a do not resuscitate (DNR) order to mark response “1,” “life expectancy is [6] months or fewer.”
       Question M0290, High Risk Factors, is similar to the previous two. This question evaluates whether there are any high risk factors that will impede the patient’s ability to recover from this illness. The instructions to answer this question are, however, limited. There is no definition for heavy smoking in response “1” or obesity in response “2.” Alcohol and drug dependency may be more defined, but you may not have this information during the first visit. Again, it is vital to use interviewing, a review of the patient’s history, and physician consultation to provide the most accurate responses possible.

       Editor’s note: The preceding questions and answers came from the Centers for Medicare & Medicaid Services (CMS) website and are available at http://www.qtso.com/guides/hha/cat4.pdf.