>> Female Speaker: Welcome to the Centers for Medicare
and Medicaid Services Module, Section N, Medications.
This module will introduce learners
to HIS Section N, Medications,
which includes items N0500, Scheduled Opioid,
N0510, PRN Opioid, and N0520, Bowel Regimen.
In this module, we are only going to focus
on discussing specifications for the individual measures.
Although items in this section
are also used to calculate the hospice composite measure,
we will not cover the details of that measure in this series.
For more information on the composite measure,
we recommend you review the Q.M. user's manual,
which can be found using the link on the resource slide.
This is the sixth of eight modules in the larger series,
HIS Coding Guidance.
The series, overall, is intended for users
who are familiar with HIS coding and submission guidelines.
For newer users,
we recommend starting with the HIS manual
and older trainings first.
These modules will not cover all items in all sections.
Learners may choose to listen to the entire series
or may choose to listen to one or two modules
that are of most interest to them,
meaning the modules in this series
can be watched independently
or as a group.
Included here on slide two is a list of acronyms
that will be used in this presentation
listed in alphabetical order.
After completion, learners will be able to identify the items
that compose Section N, Medications,
describe the intent of the measure,
and the corresponding quality measures.
The items in this section correspond to NQF
#1617, Patients Treated with an Opioid
Who are Given a Bowel Regimen and NQF
#3235, Hospice and Palliative Care Composite Process Measure,
Comprehensive Assessment and Admission.
Section N gathers information on opioids and bowel regimens.
The intent of the items in this section
and the associated quality measure
is about preventing opioid induced constipation,
not about whether opioids were initiated to treat symptoms
or whether a bowel regimen was initiated
to prevent non-opioid induced constipation.
The first item in this section is N0500,
which collects information on scheduled opioids.
Opioids are commonly used in the management of pain
and other symptoms.
N0500, Reports of Clinical Documentation,
supports that a scheduled opioid
was either initiated or continued
and if so, the date the order was received.
For purposes of HIS collection,
scheduled opioids can be initiated
or continued for any reason regardless of symptom,
not just pain.
Standing orders and comfort kit initiation is defined
as the date the order was received by the hospice
and there was documentation of instruction
to begin using the medication or treatment.
For orders continued from previous care settings,
you should complete N0500 based on scheduled opioids
for which the hospice has received orders.
The next item in Section N is N0510.
This item collects information on opioids as well,
but is exclusive to PRN opioids.
Now, let's look at coding tips for PRN opioids.
N0510 reports whether a PRN opioid
was either initiated or continued
and, if so, the date the order was received.
As with N0500, the PRN opioid can be initiated
for any reason regardless of symptom.
Standing orders and comfort kit initiation is defined
as the date the order was received by the hospice
and there was documentation of instruction
to begin using the medication or treatment.
For orders continued from previous care settings,
N0510 should be completed based on PRN opioids
for which the hospice has received orders.
Now that we have a general understanding
of the previous two items in Section N,
let's take a look at N0520, Bowel Regimen,
and see how the items all come together
and are ultimately used to calculate the patients
treated with an opioid
who are given a bowel regimen quality measure.
N0520 reports whether a bowel regimen
was initiated or continued
and the date of initiation or continuation.
You would only complete this item if N0500A
or N0510A equals one,
meaning the patient is on some type of opioid.
So, if the patient is not on an opioid, skip N0520,
regardless of whether they are on a bowel regimen or not.
At first, this skip pattern may seem strange,
but if we think about the intent of the items in this section,
it should make more sense.
Remember, this section is exclusive
to preventing opioid induced constipation.
So, if the patient is not on an opioid,
there is no need to report information
on their bowel regimen.
For non-pharmacological bowel regimens,
for example, prune juice,
report the date the hospice nurse or clinician
discussed the intervention with the patient or caregiver.
For standing orders and comfort kits,
initiation is defined
as the date the order was received by the hospice
and there was documentation of instruction
to begin using medication or treatment.
To reiterate what I mentioned earlier,
this item is a conditional item,
meaning you would complete only
if the patient is taking a scheduled,
or PRN, opioid.
It is important to remember that per the HIS instruction,
if the patient is not on an opioid,
skip this item even if the patient is on a bowel regimen
for non-opioid induced constipation.
NQF #1617 is a percentage of patient
stays treated with opioids
that are offered or prescribed a bowel regimen
or there is documentation of why this was not needed.
While the HIS asks about scheduled and PRN opioids,
the quality measure includes only patients
on scheduled opioids.
As with a bowel regimen item itself,
this quality measure is also conditional.
This measure only applies to patients
who received a scheduled opioid.
If the patient is not on a scheduled opioid,
they are excluded from the denominator.
These patients are considered
neutral from a Q.M. calculation standpoint.
For patients not on a scheduled opioid,
whether you initiate a bowel regimen is irrelevant
for quality measure calculation purposes.
The initiation or lack thereof of a bowel regimen
can neither count for you
or against you for these excluded patients.
Again, we go back to the intent of this item and measure,
which is exclusively focused
on preventing opioid induced constipation.
If the patient is not on a scheduled opioid,
their bowel regimen status is irrelevant for this Q.M.,
even if you did start one for non-opioid induced constipation.
To meet the criteria for the numerator,
patients that are taking a scheduled opioid must be offered
and/or prescribed a bowel regimen
within one day of the scheduled opioid
being initiated or continued.
Or, there must be documentation as to why a bowel regimen
was not needed.
While this series overall is intended for users
who are familiar with HIS coding and submission guidelines,
information regarding the Hospice Quality
Reporting Program
can be found by clicking the hyperlink
on this resource slide.
This resource slide also contains hyperlinks to specifics
on the HIS hospice quality measures, the Q.M. users manual,
and the HIS manual V2 with the change table.
The Hospice Quality Help Desk is available to assist
with general questions
about the hospice quality reporting program.
This concludes the module Section N, Medications.
This module included information on the items
and quality measures in Section N,
including the PRN and scheduled opioid items
as well as the bowel regimen item.
This is the sixth of eight modules in this series,
Hospice Item Set Coding.
The other modules in this training series are listed here,
and we encourage you to view these training modules
as well to understand more about HIS coding
and learn how it may help you and your hospice.
Thank you for viewing this presentation.
The information presented was correct as of the date
it was recorded.
This presentation is not a legal document.
Official Medicare program legal guidance is contained
in the relevant statutes, regulations, and rulings.