March 30 2026
OASIS Answers
Categories: HOPE

Assessing Shortness of Breath in HOPE

by Kerry Termine, DPT, HCS-D, COS-C, CHS-C

Overview of Dyspnea Items

HOPE items J2030 – Screening for SOB and J2040 – Treatment for SOB are intended to document signs and symptoms of dyspnea/shortness of breath in hospice patients.

Per HOPE guidance from CMS, the items should incorporate information from the interview with the patient and/or family/caregiver, as well as the clinical assessment and judgment of the assessing nurse if the patient is unable to participate. Item completion should be based on what is determined during the assessment visit and/or included in the clinical record. Do not use sources external to the clinical record.

J2030. Screening for SOB

The intent of this item is to capture whether an assessment of the patient for the presence of shortness of breath took place.

Key pieces of guidance to keep in mind include:

A screening for shortness of breath must include evaluating the patient for presence/absence of shortness of breath and, if shortness of breath is present, rating its severity.
The assessing clinician may determine that shortness of breath is an active problem, even if shortness of breath does not occur during the assessment visit.
There may also be situations where an order for Oxygen as needed (PRN) exists, but the assessing clinician does not determine shortness of breath to be an active problem for the patient at the time of the screening.

J2040. Treatment for SOB

The intent of this item is to capture whether treatment for shortness of breath was initiated by the hospice provider, and if so when it was initiated.

Key pieces of guidance to keep in mind include:

For non-medication interventions (for example, fans, positioning, patient education efforts) there will not be any orders; in this case, use the date on which the hospice first discussed the intervention with the patient/caregiver.
For pharmacologic interventions, treatment is considered initiated when the hospice has received the order and there is documentation that the patient/caregiver was instructed to begin use of the medication or treatment.
For comfort kits or pre-printed admission orders, if the date the hospice received the order is different than the date the hospice instructed the patient/caregiver to begin using the treatment/medication, “date treatment initiated” would be the date, when both conditions were met (that is, the date the hospice received the order and instructed patient/caregiver to begin use).
If the patient received multiple types of treatment for shortness of breath (for example, oxygen and education about positioning), enter the date that the first treatment was initiated.

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