Therese: Welcome to the Home Health Training Part One.
My name is Therese Rodda and I'll be presenting
"Section N. Medication New Item and Revisions".
I am a physical therapist with experience
in direct patient care, education and administration.
My experience includes inpatient-outpatient rehabilitation,
home health, and hospice settings.
Currently I'm an associate at Abt Associates
in Cambridge, Massachusetts.
Here are the objectives for our session today.
At the conclusion of this training,
you should be able to discuss the new medication assessment
item in Section N
of the Outcome and Assessment Information Set
or OASIS version E,
explain the definition added to Section N,
discuss new coding tips for the medication management items,
M2020 and M2030,
addressing patients residing in assisted living facilities
or ALFs.
Here is an overview of Section N and OASIS-E.
The medication items from OASIS-D1 have been reorganized
into Section N to align with the other post-acute care
or PAC setting assessment instruments.
N0415. High-Risk Drug Classes: Use and Indication.
This is a new standardized PAC assessment item added
to OASIS-E.
Continuing with our overview, M2001. Drug Regimen Review,
M2003. Medication Follow-Up,
M2005. Medication Intervention.
In these items, the rationale has been added
to each to align with the other PAC settings
along with some other minor changes.
For M2010. Patient/Caregiver High-Risk Drug Education,
the patient's reconciled medication profile was added
as a data source.
M2016. Patient/Caregiver Drug Education Intervention
was removed.
For M2020. Management of Oral Medications,
their coding tips were updated.
And for M2030. Management of Injectable Medications,
this item is no longer collected at follow-up.
And again, the coding tips were updated.
We will start by taking a closer look
at the new assessment item in Section N.
N0415 High-Risk Drug Classes: Use and Indication.
Here is a screenshot of the new item in this section.
For OASIS-E, this item will be collected
at start of care, resumption of care,
and at discharge from the agency.
The intent of this item is to record
whether the patient is taking
any medications in specified drug classes,
and whether the indication was noted
for taking the prescribed medications.
The item rationale stems from the fact
that patients taking medications in high-risk drug classes
or categories are at high risk
for side effects that can adversely affect health, safety
and quality of life.
Now, we will review the definition
for adverse drug reaction.
This is a form of adverse consequence.
It may either be a secondary effect
of a medication that is usually undesirable
and different from the therapeutic effect
of the medication or any response
to a medication that is noxious and unintended and occurs
in doses for prophylaxis, diagnosis, or treatment.
The term side effect is often used interchangeably
with adverse drug reaction.
However, side effects are but one
of the five adverse drug reaction categories.
A side effect is an expected
well-known reaction that occurs with a predictable frequency
and may or may not constitute an adverse consequence.
Other categories
for an adverse drug reaction are hypersensitivity,
idiosyncratic response, toxic reactions
and adverse medication interactions.
Now, we will look at the item guidance for N0415.
The following data sources can be used
to complete this item.
We have medical record review, clinical progress notes,
other recent clinical documentation.
For example, the discharge
or transfer summary. Information can also be gathered
from discussions with other healthcare providers
at prior sites of care, patients and or caregivers.
For column one, using the data sources
on the previous slide, you will determine
if the patient is taking any prescribed medications
in any of the drug classes listed.
Next, you will check column one determining
from the data sources
if there is a documented indication
for all of the the checked medications.
Check column two for all that include an indication.
Check all that apply for both columns.
For Code 1, Is Taking,
this includes a medication that is part
of the patient's current drug regimen,
even if it is not taken on the day of assessment.
It also includes anticoagulants
such as target-specific oral anticoagulants,
which may or may not require laboratory monitoring.
Medications according
to the medication's therapeutic category
or drug classification,
regardless of why the patient is taking it.
You do not code antiplatelet medications,
such as aspirin/extended release
as N0415E. Anticoagulant.
We have also listed a couple
of other medication examples here
for your reference that would not be coded.
Dash is a valid response for this item.
However, dash indicates no information
and CMS expects dash to be used in a rare occurrence.
So what do high-risk drug classes include?
Combination medications.
These medications should be coded in all categories
or pharmacological classes that constitute the combination.
For example, prochlorperazine is dually classified
as an antipsychotic and an antiemetic.
Code as an antipsychotic, regardless of how it is used.
For long-acting medications, count only if they are part
of the current drug regimen at the time of the assessment.
For example, transdermal patches designed
to release medication over a period of time.
Typically, three to five days would be considered
long-acting medications and are included
as long as they are part
of the patient's current drug regimen.
Include medications administered by any route.
So you would include oral, topical, inhalant,
injection, sublingual, parenteral, and by infusion
in any setting, either the home, hospital emergency room,
physician's office, clinic, any of those places,
while a patient of the home health agency.
Include newly prescribed medications that are part
of the current drug regimen,
even if the medication is not yet in the home
and or the first dose has not yet been taken.
Now, what is not included
for N0415, herbal and alternative medications by any route
are not included.
These products are considered to be dietary supplements
by the US Food and Drug Administration
and should not be counted as medications.
Examples would include melatonin, chamomile
and valerian root.
The discussion of guidance for N0415 is complete.
So we turn our attention to the updates for existing items,
M2020 and M2030, Management of Oral Medications
and Management of Injectable Medications.
Here is an overview of the changes.
Minor changes were made to guidance
for both items throughout to improve or enhance clarity.
Coding tips for both items were updated
to help clarify medication management for patients residing
in assisted living facilities.
For a patient residing
in an assisted living facility where the facility holds
or locks up patient's medication,
report the patient's ability
to take the correct oral medications,
including proper dosage, reliably and safely
at the correct times.
Determine ability based on observation and assessment
of the complexity of the patient's drug regimen,
as well as patient characteristics,
including cognitive status,
vision, strength, manual dexterity and general mobility.
Assessment includes consideration
of whether a patient can get to the location
where the medications are routinely stored
at the correct times,
recognizing that someone would need to make the medication
available to the patient once they are at the location.
For example,
a nursing office or medication cart,
Whether or not
the patient can recognize the correct medication dose
or doses and take their oral and injectable medications.
You would select response zero, one, two or three,
depending on the level and timing of assistance required
on the day of assessment to allow the patient
to take/inject the correct doses
of all oral or injectable medications reliably and safely
at the correct times.
Today, you learned
about the organization of medication items into Section N.
We discussed the new assessment item,
N0415. High-Risk Drug Classes: Use and Indication
and a new definition.
We also reviewed the new coding tips
for M2020. Management of Oral Medications
and M2030. Management of Injectable Medications
to enhance clarity
about coding medications
for patients residing in assisted living facilities.
We welcome questions.
And if you would like to submit questions you have
about this presentation,
please send them to PACTraining@EconometricaInc.com
by August 31st, 2022.
All questions submitted will be reviewed.
And those that are most common will be included
in Q&A documents published after the virtual event.
We invite you to attend the practice coding workshop
that will be held in September.
Based on the review of questions submitted,
selected questions will be discussed in a Q&A session
during the September, 2022 virtual live event.
Thank you.