Home Health OASIS Coding: Defining Falls for J1800 and M1033

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

Existing Falls Definitions: J1800 – Any Falls Since SOC/ROC and M1033 – Risk for Hospitalization

Per the OASIS-E Guidance Manual, a fall for J1800 – Any Falls Since SOC/ROC and for M1033 – Risk for Hospitalization is defined as,

“[An] unintentional change in position coming to rest on the ground, floor, or onto the next lower surface (e.g., onto a bed, chair, or bedside mat). The fall may be witnessed, reported by the patient or an observer, or identified when a patient is found on the floor or ground. Falls are not a result of an overwhelming external force (e.g., a patient pushes another patient.”

The falls definition for OASIS data collection also includes intercepted falls.

“An intercepted fall occurs when the patient would have fallen if they had not caught themself or had not been intercepted by another person. However, an anticipated loss of balance resulting from a supervised therapeutic intervention where the patients balance is being intentionally challenged during balance training is not considered a fall.”

These definitions are true for any patient assessment where J1800 and M1033 are collected.

  • For J1800, the assessment should consider any falls meeting the above definitions that have occurred since the most recent SOC/ROC, regardless of where the fall occurred.
  • For M1033, Response 1 – History of falls (2 or more falls – or any fall with an injury – in the past 12 months) should consider any witnessed and/or unwitnessed falls meeting the above definitions, when there have been 2 or more falls or at least one fall with an injury.

Expansion of the Falls Definition for J1800 – Any Falls Since SOC/ROC and M1033 – Risk for Hospitalization

As of the release of question 5 from the April 2024 Q&As, CMS has provided additional clarification on the definition of a fall used for the purposes of coding both J1800 – Any Falls Since SOC/ROC and M1033 – Risk for Hospitalization.

The definition of a fall for both of these items now also includes,

“Falls that occur due to a medical event, such as a seizure, are considered a fall.”

Questions related to OASIS coding and documentation of the OASIS responses can be sent to the Home Health Quality Help Desk: homehealthqualityquestions@cms.hhs.gov.

If you are one of the thousands of home health clinicians that are intrigued and fascinated by OASIS data collection, consider meeting with the team at OASIS Answers at an upcoming Blueprint for OASIS Accuracy 2-day workshop.

______

Follow OASIS Answers on FacebookInstagram, or LinkedIn, or sign up for our email list to keep on top of new CMS information related to HHVBP and OASIS accuracy.

share this article on:

share this article on:

More from the blog

by Elaine Gardner, MS, RN, COS-C, CPHQ, CHPN CMS Updates ...

by: Lori Marmon PT, MBA, COS-C What is a quality ...

by Elaine Gardner, MS, RN, COS-C, CPHQ, CHPN Updated CMS ...

by Megan Bernier, MSPT, RAC-CT, COS-C 30-Day Public Comment Period ...

by Elaine Gardner, MS, RN, COS-C, CPHQ, CHPN On June ...

by Kerry Termine, DPT, HCS-D, COS-C Existing Falls Definitions: J1800 ...