OASIS-Central

OASIS B-1: The data elements in OASIS B-1 asked the clinician to rate the severity of each condition. Responses ranged from “0,” asymptomatic, no treatment needed at this time, to “4,” symptoms poorly controlled, history of rehospitalizations. Because the instructions did not mention V codes, clinicians did not know whether to complete the severity ratings for V codes. There was also a widespread belief that the primary diagnosis should have the highest severity level, with other diagnoses prioritized in decreasing order of severity.

OASIS-C: Symptom control is the new term, replacing severity index. The descriptions of each response have not changed. The data element notes that symptom control ratings do not apply to V or E codes.

An instruction notes that clinicians should not use the symptom control rating as the driving force in prioritizing diagnoses. It is one factor to consider. A condition with a lower rating could be the principal diagnosis. Examples: 1) The diabetic patient receives daily visits to treat gangrene. His primary diagnosis is diabetes, with a symptom control rating of 2; followed by gangrene, with a symptom control rating of 3. A manifestation of an underlying condition is the primary reason for homecare services. 2) The patient receives physical and occupational therapy visits (five a week for four weeks) to treat an exacerbation of multiple sclerosis (rating of 2). The patient’s daughter, a registered nurse, manages the patient’s unstable diabetic condition (rating of 3). Multiple sclerosis is the principal diagnosis because it requires the most intensive service.

This is an excerpt from the article “Revisions Clarify Completion of OASIS-C Diagnoses Data Elements”by Diane Omdahl, which originally appeared in the June 2009 edition of Homecare Direction. Learn more about Homecare Direction here!