M1400: CMS OASIS Q&As

Since the patient’s supplemental oxygen use is not continuous, M1400 - Dyspnea should reflect the level of exertion that results in dyspnea without the use of the oxygen. The correct response would be 4 - At rest (during day or night). It would be important to include further clinical documentation to explain the patient’s specific condition.

Sleep apnea being treated by CPAP is not the same as dyspnea at rest (Response 4 for M1400). M1400 - Dyspnea asks about dyspnea (shortness of breath), not sleep apnea (absence of breath during sleep). The two problems are not the same. Dyspnea refers to shortness of breath, a subjective difficulty or distress in breathing, often associated with heart or lung disease. Dyspnea at rest would be known and described as experienced by the patient. Sleep apnea refers to the absence of breath. People with untreated sleep apnea stop breathing repeatedly during their sleep, though this may not always be known by the individual. If the apnea does not result in dyspnea (or noticeable shortness of breath), then it would not be reported on M1400. If, however, the sleep apnea awakens the patient and results in or is associated with an episode of dyspnea (or noticeable shortness of breath), then Response 4 - At rest (during day or night) should be reported.

M1400 - Dyspnea reports what is true on the day of the assessment (the 24 hours immediately preceding the home visit and the time spent by the clinician in the assessment). If the patient has not demonstrated or reported shortness of breath during that timeframe, the correct response would be 0 - Not short of breath even though the environment or patient activities were modified in order to avoid shortness of breath.

When completing M1400 - Dyspnea, the assessing clinician will assess and report what caused the patient to experience dyspnea on the day of the assessment. The responses represent increasing severity of shortness of breath and include examples that the clinician can use in order to make the determination regarding the amount of effort that caused the patient’s dyspnea. The examples included in Responses 2 - With moderate exertion and 3 - With minimal exertion are used to illustrate the degree of effort represented by the terms moderate and minimal. Response 3 - With minimal exertion or agitation includes the examples of eating, talking, or performing other ADLs. The reference to other ADLs means activities of daily living that only take minimal effort to perform like grooming. The assessing clinician can use the examples to make the determination regarding the amount of effort that caused the patient's dyspnea. The clinician is not limited to selecting Response 2 - moderate exertion, if the patient becomes short of breath while dressing if just minimal effort was exerted and resulted in dyspnea. For example, if a patient lifted their arm to insert it into the sleeve of the shirt and this minimal amount of effort caused the patient to become short of breath, the appropriate response would be Response 3 - minimal exertion, even though they became short of breath during the process of dressing. This patient would more than likely also have become short of breath while eating or performing other activities requiring only minimal exertion. The assessing clinician will consider the examples as a guide when determining whether it was moderate or minimal exertion that caused the patient's dyspnea. A patient who became short of breath after just bending over to pick something up or tie a shoe could be considered a Response 3 - With minimal exertion, if in the clinician's judgment, the patient became dyspneic after exerting just minimal effort.

Each OASIS item should be considered individually and coded based on guidance specific to that item. The definitions for intermittent and continuous oxygen use provided in the guidance for O0110 Special Treatments, Procedures, and Programs are intended to be specifically used to support coding for O0110C1 - Oxygen Therapy, O0110C2 - Continuous, and O0110C3 - Intermittent. M1400 - When is the patient dyspneic or noticeably Short of Breath? identifies the level of exertion/activity that results in a patient’s dyspnea or shortness of breath, regardless of any underlying condition. For M1400, if the patient uses oxygen continuously (at all times during the day of assessment, with only brief interruptions), enter the response based on assessment of the patient’s shortness of breath while using oxygen. If the patient uses oxygen intermittently, enter the response based on the patient’s shortness of breath WITHOUT the use of oxygen. Responses are based on the patient’s actual use of oxygen in the home, not on the physician’s oxygen order.