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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Home Health Care (HHC)
Chapter 12
Addendum E
Primary Components Of A Home Care Patient Assessment
Assessment Component And Elements Within Each Component
Related OASIS Item(s)
Telephone call prior to visit
•  Telephone availability
•  Setting appointment time
M0770, M0400, M0410, M0560
Basic demographic information
•  Name, address, age, gender, pay source, etc.
Entrance to home
•  Stairs or structural barriers
•  Patient's ambulatory status
•  Patient remembered telephone call & appointment
•  Interior of home (as move from one room to another)
M0560, M0570
Interior of home (as move from one room to another)
•  Lighting
•  Floor coverings
•  Room temperature
•  Electrical outlets
•  Doorways or other structural barriers
•  Walls, windows, window coverings
•  Odors (gas from stove, urine, feces) also M0520-M0540
•  Kitchen (where you might wash your hands)
- water availability, status of sink
- appliances available
- food out on counter tops or table
- evidence of insects or rodents
- medications present in bottles or scattered
•  Bathroom (where you might wash your hands or what you ask to see to set up aide care plan)
- water availability, status of sink
- bathtub or shower
- assistive equipment (grab bars, shower chair)
- toilet
- soiled clothes with urine or fecal odor
- medications present in bottles or scattered
M0310, M0320, M0330, M0750
also M0520-M0540
also M0780-M0800
M0670, M0680
also M0520-M0540
also M0780-M0800
History of present condition and symptoms
•  Hospitalization and reasons
•  Onset of current illness
•  Other comorbidities (severity and management)
•  Presence of high risk factors
•  Life expectancy
M0250, M0500, M0510
Family/caregiver assistance
•  Living situation
•  Availability of family/caregiver assistance
•  Other assistance needed and received
M0300, M0340
M0350, M0360
M0360-M0380, M0820
Medication inventory
•  Walk to where meds are kept
•  Assess knowledge of medication schedule, dosage, etc.
•  Assess ability to administer prescribed medications
M0410, M0560
Physical assessment
•  Vital signs
- orthostatic BP
- comprehension of instructions
•  Weight
- comprehension of instructions
- ability to stand, step on scale
•  Head
- vision
- hearing
•  Skin condition
•  Musculoskeletal and neurological
- joint function, grasp, pain, etc.
- neurologic
•  Cardiorespiratory
- dyspnea
- lung sounds; check ability to dress upper body
- circulation in lower extremities; check ability to dress lower body
•  GI/GU
- urinary status
- bowel status
•  Nutritional status
M0400, M0560-M0570
M0400, M0560-M0570
M0640-M0660, M0780-M0820
also M0410-M0430,
M0710-M0720, M0760
Emotional/behavioral status assessment
•  Review any information not gathered already in sufficient detail
M0670-M0680, M0730-M0760
Data review (in preparation for care planning)
•  Primary diagnosis and comorbidities
•  Severity index
•  Prognosis and rehab prognosis
•  Need for psychiatric nursing services
M0230, M0240
M0260, M0270
- END -

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