M1860: CMS OASIS Q&As

Because of the structure of the response options, the usual status convention (what is true greater than 50% of the time) does not apply for M1860 - Ambulation/Locomotion. For the patient who on the day of assessment is able to both walk with or without assistance, and use a wheelchair, code M1860 Ambulation based on their ability to ambulate. For the ambulatory patient who needs assistance ambulating during any part of the day of assessment, but at times or in certain circumstances on the day of assessment can ambulate safely without assist, Response 2 is selected. A patient’s ability must be that they are safe when independent of human assistance at all times during the day of assessment in order to select either Response 0 or 1. Response 3 is selected when, on the day of assessment, a patient needs human assistance at all times in order to safely ambulate. For a non-ambulatory patient who is not bedfast, Response 4 - Chairfast, unable to ambulate but is able to wheel self independently is selected if the patient does not require any assistance wheeling self at any time during the day of assessment. Response 5 - Chairfast, unable to ambulate and unable to wheel self is selected if the patient requires any assistance to wheel self on the day of assessment. If the patient can wheel self safely for part of the day but requires assistance at times, Response 5 is selected. In order to be considered bedfast, a patient must be medically restricted to the bed or unable to tolerate being out of bed.

For M1860 - Ambulation/Locomotion, the clinician must consider what the patient is able to do on the day of the assessment, which is the 24 hours that precedes the visit plus the time in the home. If after assessment it is determined that the patient’s usual status is that they can ambulate safely with a walker and no assistance, then Response 2 - Requires use of a twohanded device to walk alone on level surfaces should be reported. This is true even if the walker does not belong to the patient and may not remain in the home.

If a patient needs no human assistance but must use a cane to ambulate safely and independently on even and uneven surfaces and negotiate stairs, Response 1 would be appropriate when scoring M1860 - Ambulation/Locomotion.

“Even and uneven surfaces” refers to the typical variety of surfaces that the particular home care patient would routinely encounter in their environment. Based on the individual residence, this could include evaluating the patient’s ability to navigate carpeting or rugs, bare floors (wood, linoleum, tile, etc.), transitions from one type or level of flooring to another, stairs, sidewalks, and uneven surfaces (such as a graveled area, uneven ground, uneven sidewalk, grass, etc.). To determine the best response, consider the activities permitted, the patient’s current environment and its impact on the patient’s normal routine activities. If, on the day of assessment, the patient’s ability to safely ambulate varies among the various surfaces the patient must encounter, determine if the patient needs some level of assistance at all times (Response 3), needs no human assistance or assistive device on any of the encountered surfaces (Response 0), needs a one-handed device but no human assistance, (Response 1) or needs a two-handed device and/or human assistance at times but not constantly (Response 2). Response 0, Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no human assistance or assistive device), is not intended to be used as a definitive indicator of homebound status. Some patients are homebound due to medical restrictions, behavioral/emotional impairments and other barriers, even though they may be independent in ambulation. Refer to the Medicare Coverage Guidelines for further discussion of homebound criteria at http://www.cms.hhs.gov/manuals/Downloads/bp102c07.pdf.

The OASIS items should report the patient’s physical and cognitive ability, not their adherence or willingness to perform an activity. You state the patient is able to ambulate independently with a walker, so we will assume you meant that the patient is able to ambulate without human assistance safely with the walker. This would be scored as response 2 for M1860 - Ambulation/Locomotion. You state the patient is unsafe ambulating because they choose not to use the walker. This patient would still be scored a response 2 unless, as you pointed out, the clinician identified some other physical, cognitive or environmental barrier that prevents the patient from utilizing the walker to assist with ambulation, e.g. fear, memory impairment, undisclosed pain associated with walker use, or other emotional, behavioral or physical impairments. If there was a barrier preventing the patient from safely utilizing the walker during ambulation, the clinician would need to determine if the patient needed someone to assist at all times in order to ambulate safely and if so, the appropriate score for M1860 would be response 3. If the patient only needed assistance intermittently, the correct response would be response 2.

A patient is considered chairfast if they cannot be made safe ambulating even with the combination of a device and the assistance of another person at all times. They are not bedfast unless they are medically restricted to the bed or cannot tolerate being out of bed. If there is no wheelchair in the home, the assessing clinician cannot make assumptions about their ability to propel it safely. The appropriate M1860 - Ambulation/Locomotion response in this case is 5 - Chairfast, unable to ambulate and is unable to wheel self”.

In the situation described, if the patient requires no human assistance while ambulating and negotiating the stairs, but requires a stair lift to traverse the stairs safely, because the stair lift is considered an assistive device for the purposes of coding M1860 - Ambulation/Locomotion, they would be scored a response 2 for if they need two hands to use the stair lift and a response 1 if they only need one hand to safely use the stair lift.

If the assessing clinician determines the patient is safe ambulating with constant human assistance, they are ambulatory. This is true whether the assistance needed is verbal cueing, reminders, contact guard, or any level of hands-on assistance. If the patient is not bedfast and is not safe ambulating even with a combination of continuous assistance and a device, they are chairfast. If the patient can only take 1 or 2 steps to complete a transfer and otherwise is unable to ambulate, they are not ambulatory.

To determine the accurate response for M1860 - Ambulation/Locomotion, the assessing clinician must determine if the knee scooter will be considered an assistive device for the purpose of ambulation. If the assessing clinician determines the knee scooter is an assistive device, then the clinician must determine if the patient is safe without the assistance of another person and assess the number of hands (one-hand or two-hands) the patient requires to safely use the device.

For M1860 - Ambulation/Locomotion Responses 4 and 5, the assessing clinician must consider the non-ambulatory patient’s ability to safely use the wheelchair, given the patient’s current physical and mental/emotional/cognitive status, activities permitted, and environment. In the scenario cited, the patient’s advanced dementia/cognitive decline is noted as a concern because the patient is unable to wheel self with purpose. Other than addressing safety on surfaces the patient would routinely encounter in their environment, CMS guidance does not detail specific criteria regarding patient ambulation or wheelchair use (i.e., how far the patient must walk, or wheel self; of if they use ambulation or wheelchair mobility with specific purpose, regularity, or efficiency). It is left to the judgment of the assessing clinician to determine the patient’s ability (i.e., does the patient’s mental status impact their safety?) and select a response accordingly.