Okay, so this is Section O,
special treatments, procedures, and programs.
Hang in there, we're almost done.
Okay, we're going to define Section O,
special treatments, procedures, and programs,
explain the new items for your new dataset version 3.0,
explain the intent, discuss coding instructions,
and then we're going to do a few scenarios.
So in Section O, for the admission assessment,
you have some new items.
O100F3, O100F4, O100G, 0100J, O100M.
So you have invasive mechanical ventilator weaning,
invasive mechanical ventilator non-weaning,
non-invasive ventilator, BIPAP or CPAP, dialysis,
and total parenteral nutrition.
There's also an addition of the influenza vaccine O250
which includes O250 A, B, and C,
and that has been added to the expired assessment.
So the intent of Section O is to identify
any special treatments, procedures, and programs
that the patient received during the stay,
and this does include the influenza vaccination status.
So here's your screenshot for O100,
for special treatments.
This applies to the admission assessment only.
The treatments, procedures, and programs listed
can affect the patient's ability to perform self care,
and mobility activities.
So, for O100F3, invasive mechanical ventilator weaning,
you will check this box if they have any type of
Electrically- or pneumatically- powered closed system,
mechanical ventilator support devices is for patient
who is unable to support his or her own respiration;
it's for a patient whom weaning attempts are expected
or anticipated at the time of admission.
They can have a patient with ventilation
be a tracheostomy, or endotracheal tube,
either nasally or orally intubated.
And the documentation should be recorded or dated
by day two of the LTCH stay
or day one is the day of admission.
For O100F4, you would check
the invasive mechanical ventilator non-weaning,
if again, any type of electrically-
or pneumatically-powered
closed system mechanical ventilator support devices,
for a patient who is unable to support
his or her own respiration, and for a patient
whom weaning attempts are not expected,
or anticipated, at the time of admission.
So these could be patients who are chronically ventilated
in the community or a facility.
It could be patients with diseases
or diagnoses, such as amyotrophic sclerosis,
or some type of irreversible neurological injury,
or diseases or dysfunctions,
such as high C-2 spinal cord injury.
Patients could be ventilated via tracheostomy,
or endotracheal tube, Nasally, or orally.
And the documentation, Again, should be recorded
by day two of the LTCH stay,
or day one is the day of admission.
And for O100G, you would check non-invasive ventilator,
for BIPAP or CPAP,
so any type of continuous positive airway pressure,
or bilevel positive airway pressure,
respiratory support devices.
The mask enables the individual
to support his or her own respiration,
and it provides enough pressure when the individual inhales,
to keep his or her airways open, which is unlike a ventilator
that essentially breathes for the individual.
This item may be coded if the patient puts on
or removes his or her own BIPAP or CPAP mask.
In addition, for other treatments,
we have O100J dialysis,
you would check if the patient undergoes peritoneal
or renal dialysis as part of their treatment plan.
You would record treatments of hemofiltration,
whether it's intermittent or continuous,
slow continuous ultrafiltration, hemodialysis,
and continuous ambulatory peritoneal dialysis.
And this item may be checked
if the patient performs his or her own dialysis.
And lastly, O100M, which stands for
total parenteral nutrition, if the patient receives
parenteral or intravenous IV feeding.
If the patient does not receive any of the above,
you would be checking O100Z, which is for none of the above;
so none of the above treatments
were received or performed by the patient.
So we have a coding scenario for O100.
Ms. M was involved in a motor vehicle accident,
leaving her in a coma.
She's admitted to the LTCH, and it is anticipated
that she'll be taken off the ventilator
she's been on for the last several months.
Documentation in Ms. M's medical record
indicates weaning attempts are expected or anticipated,
and the documentation was recorded in the care plan
on day two of the LTCH stay.
So how would you recode O100?
Are you going to check it or not check it?
Yes. Okay, so you're going to check it.
Yes, for weaning.
Ms. M is being admitted from weaning from the ventilator,
and documentation was recorded and dated on day two,
and you would check the box for F3.
Mr. L has developed difficulty breathing,
related to his diagnoses of ALS.
Because of the progressive nature of his condition,
his physician does not anticipate
he can be removed from the ventilator.
How would you code O100 for F4?
Check for F4, okay, it's for non-weaning,
so F3 is for invasive mechanical ventilator for weaning,
F4 for non-weaning because we don't think
he's going to get off of the ventilator.
Mr. G develops severe chronic obstructive pulmonary disease
after 40 years of smoking,
requires BIPAP assistance at night.
How would you code, would you check for O100?
Which one would you check for O100?
Right, Mr. G has G.
He's been prescribed BIPAP and he wears the mask nightly.
Ms. L developed acute renal failure,
related to excessive use of non-steroidal
anti-inflammatory drugs for her arthritis;
she receives hemodialysis three times a week.
How would you code O100?
You would check dialysis, right,
because her treatment plan includes dialysis.
Ms. C has been unable to eat or ingest adequate nutrients
since her bowel surgery; Ms. C receives TPN
using a peripheral inserted central catheter,
a PICC line, that infuses her nutrients 24 hours daily.
How would you code O100?
TPN, right.
Her treatment plan includes TPN.
Yes.
The question is, if you're using a central line
rather than a peripheral line, as long as it's TPN?
Yeah, they said okay,
so you're getting in a peripheral line, yes.
You're using a peripheral line?
Okay, so we'll get back to you.
That's the answer. We're running late.
Okay.
Mr. D does not require any of the special treatments,
procedures, or programs as described.
So if none of the above,
he does not require any of the above,
you need to check the box that says "none of the above."
You don't want to leave it blank.
Okay, very briefly we're going to talk about
the influenza vaccine,
because this is not a new item for you all.
It's new to the expired assessment.
So there's O250, there's an A,
there's a B, and there's a C.
The rationale being that when inflected with influenza,
older adults and persons with underlying health problems
are at increased risk for complication,
and are more likely than the general population
to require hospitalization.
An institutional Influenza A outbreak
can result in up to 60% of the population becoming ill,
with 25% of those affected developing complications
severe enough to result in hospitalization or death.
Influenza-associated mortality results not only from pneumonia,
but also from subsequent events arising from cardiovascular,
cerebral vascular, and other chronic
or immunocompromising diseases
that can be exacerbated by influenza.
So it is important to note the vaccination season.
So for this 2015/2016 vaccination season,
it began October 1st of 2015,
or when the influenza vaccine became available,
and it runs through March 31, 2016.
So the coding instructions, code 0, no,
if the patient did not receive the influenza vaccine
in your facility during this year's
influenza vaccination season.
And you would proceed to O250C
if the influenza vaccine was not received,
and you give the reason why.
You would code 1, yes, if the patient received
the influenza vaccine in this facility
during this year's influenza vaccination season,
and you would go to O250B,
and give the date that the vaccine was received.
Now as far as the date goes,
you need to make sure that you do not leave any boxes blank.
So if the month is a single digit,
you need to preface it with a 0.
If the day is a single digit, you need to preface it with a 0.
So, for example, January 7th of 2017
would need to be documented as 01/07/2017.
October 6th, 2016, would be 10/06/2016.
Now, if you do not get all eight character dates,
you do not know the entirety of those dates,
you just put a single dash,
and that needs to be entered in the first box.
For O250C, there are several coding instructions,
code 1 is the patient not in the facility
during this year's influenza vaccine,
so if they did not receive it
because they were not in your facility.
Code 2 was received it outside of your facility,
if the patient received it somewhere else,
such as their physician office,
the health fair, a grocery store,
a pharmacy, a hospital, a fire station,
during that year's influenza vaccination season.
Code 3 is they were not eligible,
there was a medical contraindication of some type,
was not received because of things such as
being allergic reaction to eggs or other vaccination components,
previous adverse reaction to influenza vaccine,
a physician order says "do not vaccinate,"
moderate to severe illness, with or without fever,
a history of Guillain-Barre Syndrome,
within six weeks of a previous influenza vaccination.
However, if the patient should be vaccinated
if any of those contraindications end.
Code 4 is offered and declined, the patient or their guardian,
their responsible party says they don't want it,
they've been informed of why it's been offered,
and they choose not to accept it.
Code 5 is you didn't offer it.
It's not offered, if the patient
or responsible party, or legal guardian,
was not offered the influenza vaccine.
Code 6 is the inability to obtain the vaccine
due to a declared shortage,
so if the influenza vaccine was unavailable in your facility
due to a declared shortage.
However, the patient should be vaccinated
once the facility receives the vaccine.
The annual supply of inactivated influenza vaccine
and the timing of its distribution
cannot be guaranteed in any year.
And then code 9 is if they didn't receive it,
but it's none of the above reasons, okay.
The code is also used if you don't know the answer,
it's unknown, all right.
So we have a coding scenario.
Ms. J received the influenza vaccine in the LTCH
during this year's influenza vaccination season
on October 2nd, 2015. How are you going to code O250?
Remember, there are several parts to O250, right,
there's A, B, and C.
So, we've got-- okay.
Unfortunately, you have to put that paper the other way around.
That is a dash.
[LAUGHTER]
If you think it's a 1, put up the 1.
Somebody show them the 1, there you go.
That's a dash.
The dash was there for other coding.
All right. So we have a 1, okay.
So yes, the person received it.
The date, 10/02/2015,
and then, obviously, you're going to skip 250C, right,
because that's reasons why you didn't get it.
We're going to skip through a couple of these
to get back on track.
So Mr. M was offered the influenza vaccine
during his LTCH hospitalization beginning in February 2015.
He refused the influenza vaccine,
asserting that whenever he's received it in the past,
he always got the flu.
So how are you going to code O250?
Okay, so, A becomes what, 0, B becomes--?
Nothing, right, and C becomes--
I don't see any numbers.
There we go, 4. Okay.
So no, you skip B, because it's not given,
and 4, it was declined.
So in summary, the treatments, procedures,
and programs listed in O100 can affect the patient's ability
to perform self care and mobility activities.
O100F3, O100F4, O100G, O100J, O100M
are all new items on the admission assessment.
When affected with influenza,
older adults and persons with underlying health problems
are at increased risk for complications
and are more likely than the general population
to receive hospitalization.
And the CDC recommends annual influenza vaccination.
Influenza vaccination items
have been added to the expired assessment.
For your action plan,
you want to review the patient's medical record
to determine whether or not the patient received
any of the treatments, procedures, or programs
at the time of admission.
For dialysis, you're going to check
if it's part of the patient's treatment plan.
And if the patient does not receive the listed treatment,
you want to be sure and check Z, none of the above.
You're going to review the patient's medical record
to determine whether the influenza vaccine
was received in the LTCH
for this year's influenza vaccination season.
You want to update your policies, procedures,
and processes for documenting, [INDISTINCT]
and for receiving of influenza vaccination.
You can ask the patient, the responsible party,
if the patient received the vaccination somewhere else.
And, again, you can practice coding scenarios;
and there were a couple of other scenarios
that were in the packet you can use as well.