Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

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
Revision:  
Assessment Component And Elements Within Each Component
Related OASIS Item(s)
PREVISIT
Telephone call prior to visit
•  Telephone availability
•  Setting appointment time
M0770
M0770, M0400, M0410, M0560
VISIT
Basic demographic information
•  Name, address, age, gender, pay source, etc.
M0010-M0160
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)
M0310
M0700
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
M0175-M0190
M0200-M0220
M0250, M0500, M0510
M0290
M0280
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
M0690-M0700
M0410, M0560
M0780-M0800
Physical assessment
•  Vital signs
- orthostatic BP
- comprehension of instructions
•  Weight
- comprehension of instructions
- ability to stand, step on scale
•  Head
- vision
- hearing
-speech
•  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
M0690
M0400, M0560-M0570
M0400, M0560-M0570
M0690-M0700
M0390
M0400
M0410
M0440-M0488
M0640-M0660, M0780-M0820
also M0410-M0430,
M0560
M0490
M0650
M0660
M0520-M0530
M0540-M0550
M0710-M0720, M0760
Emotional/behavioral status assessment
M0560-M0620
ADLs/IADLs
•  Review any information not gathered already in sufficient detail
M0670-M0680, M0730-M0760
POSTVISIT
Data review (in preparation for care planning)
•  Primary diagnosis and comorbidities
•  Severity index
•  Prognosis and rehab prognosis
•  Need for psychiatric nursing services
M0230, M0240
M0240
M0260, M0270
M0630
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Frequently Asked Questions page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.7.7887.17454

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.