As HHVBP continues to take hold nationwide, improving M1850 (Transferring) accuracy can pay off. This item impacts payments from a few different angles.
Accuracy on all the M1800 items, is crucial as they impact the calculation of functional status in PDGM and these items will be used to calculate the “Total Normalized Composite Change in Mobility” measure in HHVBP through 2024, notes Jennifer Osburn, senior clinical consultant with SimiTree Healthcare Consulting in Hamden, Conn.
Navigate nuances of M1850
The first step toward ensuring M1850 is answered accurately is to make sure that staff truly understand the response options and associated guidance.
Response “1 — Able to transfer with minimal human assistance or with use of an assistive device” is a true either/or, Osburn says.
If the patient requires both human assistance (such as verbal cues or standby supervision for safety) and a device, response “1” cannot be the correct answer, she explains.
Response “2 — Able to bear weight and pivot during the transfer process but unable to transfer self” is correct when:
- The patient uses any type of device but still needs another person’s assistance, even for verbal cues or standby assistance.
- The patient either requires both a device and minimal human assistance or requires more than minimal human assistance.
It is important to note that the “and” between bear weight and pivot in response “2” truly means that the patient must be able to pivot and bear weight during the transfer, notes Ohio-based independent home health and coding expert Brandi Whitemyer.
If the patient is unable to do one or the other, then response “3” is more appropriate, she adds.
Response “3 — Unable to transfer self and is unable to bear weight or pivot when transferred by another person” is the appropriate choice when the patient cannot bear weight or pivot and is not bedfast, Osburn says.
For M1850, “bedfast” means the patient is “confined to the bed, either per physician restriction or due to a patient’s inability to tolerate being out of the bed,” per OASIS guidance.
Response “4 — Bedfast, unable to transfer but is able to turn and position self in bed” and response “5 — Bedfast, unable to transfer and is unable to turn and position self” would be assigned for patients who are unable to do the transfer.
Try this practice scenarios for M1850
Scenario: A patient who has multiple sclerosis is able to stand with a walker and make tiny steps to pivot from chair to the bedside commode right next to the bed. The patient also requires a caregiver to support his body weight using a gait belt during the process.
In this case, M1850 would be answered with response “2.”
However, if this same patient declines in his disease process and now must be transferred with a Hoyer to his electric wheelchair where he cannot bear weight and pivot, he would be coded as a “3” since he can tolerate being out of bed, even if for short periods at a time.