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Coding Preparations for PDGM: Review OASIS Item M1033

Posted on Monday, August 19, 2019 3:18 AM

By Sue Payne, Corridor’s Vice President & Chief Clinical Officer

As we prepare for the Patient-Driven Groupings Model (PDGM) to replace the Home Health Prospective Payment System (HH PPS) on Jan. 1, 2020, it’s a great time to review some of the OASIS items that drive functional adjustment scoring. Under PDGM, M1033 Risk for Hospitalization will be one of these items.

M1033 Risk for Hospitalization is an OASIS item that our industry has not paid as much attention to during OASIS reviews. It is a challenging OASIS item to respond to, given there are multiple time points for the various parts of the question. It is a question geared towards determining how at risk the patient is for hospitalization, so, you must check any items that apply.

For example, some of the signs that are listed include history of falls in the past 12 months, reported or observed difficulty complying with medical instructions in the past 3 months and/or unintentional weight loss in the past 12 months. This question requires a considerable amount of research since it is so specific in the timing and types of information being asked.

Given its’ complexity and the fact that agencies often rely on software that alerts them to risk for hospitalization, it is understandable how the industry may have not spent as much time focused on answering this OASIS item.

Under PDGM, if 4 or more items are checked on M1033 (excluding #8,9,10), you can receive 11 more points in addition to other responses on the ADL questions that drive the functional low/medium/high scoring. This gives the industry new reason to ensure the accuracy of this question.

It is unrealistic to task a clinician with backtracking through months of documentation to determine if any of these signs apply. Agencies may want to determine if their EMR has a place that captures some of this data already and if not, establish a specific location to gather this type of information.

Coding and OASIS accuracy will be crucial to maintain compliance and succeed under PDGM. Corridor’s dedicated coders provide outstanding accuracy, best practices and extensive quality assurance protocols to ensure the reliability you’ll need.  For more information on what Corridor has to offer please visit our website.


About Corridor

Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!

For additional information, please contact Corridor at 1-866-263-3795.

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