Making sense of CMS guidelines is more challenging than ever after the launch of OASIS-E and the abundance of changes that go along with it. KanTime’s OASIS Spotlight series will spotlight specific OASIS items to simplify the ruling and help clinicians significantly improve their understanding of OASIS so they can move forward with accuracy.
K0415: High-Risk Drug Classes: Use and Indication
The intent of N0415 is to identify if the patient is taking any prescribed medications in the specified drug classes and whether the indication was noted for all medications in the drug class.
Clinicians are expected to utilize multiple sources to determine the appropriate responses for N0415
- Facility medical records
- History and Physical
- Transfer documents
- Discharge summaries
- Medication lists/records
- Clinical progress notes
- Discussions with acute care hospital staff, other clinicians, the patient/family/caregiver(s)
- Start of Care
- Resumption of Care
- Discharge from Agency
SOC/ROC and Discharge
- Is taking
- Check if the patient is taking any medications by pharmacological classification, not how it is used, in the following classes
- Indication noted
- If Column 1 is checked, check if there is an indication noted for all medications in the drug class
CMS does not specify a source for identifying the therapeutic category and/or pharmacological classification.
Coding Instructions and tips per the OASIS-E Guidance Manual:
- If Column 1 is checked (patient is taking medication in the drug class), review patient documentation to determine if there is a documented patient-specific indication noted for all medications in the drug class (Column 2).
- Code medications according to the medication’s therapeutic category and/or pharmacological classification, regardless of why the patient is taking it.
- Code a medication that is part of a patient’s current drug regimen, even if it was not taken on the day of assessment.
- At discharge, N0415 identifies medications included in the patient’s prescribed drug regimen at discharge, even if the medication was not taken on the day of assessment, and whether or not it is expected to be taken after discharge.
- Do not code antiplatelet medications such as aspirin/extended release, dipyridamole, or clopidogrel as N0415E, Anticoagulant.
- Include any of these medications used by any route (e.g., PO, IM, transdermal, or IV) in any setting (e.g., at home, in a hospital emergency room, at physician office or clinic) while a patient of the home health agency.
- Medications that have more than one therapeutic category and/or pharmacological classification should be coded in all categories/classifications assigned to the medication, regardless of how it is being used.
- Count long-acting medications, such as fluphenazine decanoate or haloperidol decanoate, that are given every few weeks or monthly only if they are part of the current drug regimen at the time of assessment.
- 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 been taken.
- A transdermal patch is designed to release medication over a period of time (typically 3–5 days); therefore, transdermal patches would be considered long-acting medications for the purpose of coding the OASIS and are included as long as it is part of the patient’s current drug regimen.
- Combination medications should be coded in all categories/pharmacologic classes that constitute the combination.
- Herbal and alternative medicine products are considered to be dietary supplements by the Food and Drug Administration (FDA). Therefore, they should not be counted as medications for N0415.
Stay tuned for next Monday’s spotlight so your practice can continue to stay ahead of the curve and provide elite patient care through the Oasis E changes.
We provide clinicians that are part of the Kantime enterprise system with links to the guidance from CMS for each individual OASIS item.
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