OASIS-Central

If someone asked clinicians about the most difficult or confusing data element in the OASIS-C data set, it’s likely there would be a tie for first place: M2250, plan of care synopsis, and M2400, intervention synopsis. Homecare DIRECTION will help ease some of the confusion by looking at when to complete these data elements and how to identify the plan of care and interventions involved. Let’s clarify each piece of information that is needed to answer these questions accurately.

Both M2250, plan of care synopsis, and M2400, intervention synopsis, ask about interventions on the physician-ordered plan of care. Exactly what is the plan of care? The document formerly known as the CMS-485 is the plan of care everyone knows. At start of care and recertification, the clinician works with the physician to develop a plan of care, incorporating applicable orders.

Less recognized as the plan of care are the verbal orders that modify the original plan. Each new verbal order takes its place as part of the plan. Example: On admission, the plan noted four weeks of skilled nursing visits. Two weeks later, the physician added two more weeks of visits. That verbal order became part of the plan.

M2250

Then it’s necessary to figure out exactly which plan and verbal orders come into play when determining the answers to these data elements. M2250 applies at the start and resumption of care. Any orders, either on the plan of care or verbal orders, that the agency receives on or before the date in M0090, date assessment completed, come into play. Example: The start of care date is January 2. The nurse completes the assessment on January 6. She had compiled the plan of care on January 3 and sent it to the physician. On January 5, the physical therapist completed his evaluation and received physician orders for therapy, and the nurse completed the assessment. The response M2250 can reflect the orders on the plan of care and the therapy evaluation.

The clinician has up to five days to complete the start of care assessment and two days for the resumption of care. Completing the assessment earlier could limit the pool of orders. Example: Another patient was admitted on January 2. The nurse completed the assessment on January 3. Only orders received on those two days would come into consideration for M2250.

This is an excerpt from the article “Recognizing the Plan of Care Key to Completion of M2250, M2400” by Diane Omdahl, which originally appeared in the January 2010 edition of Homecare Direction. Learn more about Homecare Direction here!