Medicare's draft OASIS-E assessment, effective January 2023, expands its data collection on the patient's cognition to include 12 more questions. Medicare has incorporated the Brief Interview for Mental Status (BIMS) for the home health clinician to evaluate cognitive impairment and possible dementia. The BMIS is currently used in the Minimum Data Set (MDS), the assessment tool used in nursing homes.
The presence of dementia is, of course, a risk factor that affects the home health careplan.
After assessment of cognition, confusion and anxiety, OASIS items M1700, M1710 & M1720, the clinician is asked if the Brief Interview for Mental Status (BIMS) is indicated:
C0100. Should Brief Interview for Mental Status (C0200-C0500) be Conducted? Attempt to conduct interview with all patients.
0. No (patient is rarely/never understood)
1. Yes
If C0100 is 1. Yes then completion of the next 7 questions is indicated. The first section includes one (1) questions that evaluates immediate recall.
C0200. Repetition of Three Words
Ask patient: “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are: sock, blue, and bed. Now tell me the three words.” Document number of words repeated after first attempt.
0. None
1. One
2. Two
3. Three
After the patient's first attempt, repeat the words using cues ("sock, something to wear; blue, a color; bed, a piece of furniture"). You may repeat the words up to two more times.
C0300. Temporal Orientation
Ask patient: "Please tell me what year it is right now."
A. Able to report correct year
0. Missed by > 5 years or no answer
1. Missed by 2-5 years
2. Missed by 1 year
3. Correct
Ask patient: "What month are we in right now?"
B. Able to report correct month
0. Missed by > 1 month or no answer
1. Missed by 6 days to 1 month
2. Accurate within 5 days
Ask patient: "What day of the week is today?"
C. Able to report correct day of the week
0. Incorrect or no answer
1. Correct
C0400. Recall
Ask patient: "Let's go back to an earlier question. What were those three words that I asked you to repeat?"
A. Able to recall “sock”
0. No – could not recall
1. Yes, after cueing ("something to wear")
2. Yes, no cue required
B. Able to recall “blue”
0. No – could not recall
1. Yes, after cueing ("a color")
2. Yes, no cue required
C. Able to recall “bed”
0. No – could not recall
1. Yes, after cueing ("a piece of furniture")
2. Yes, no cue required
C0500. BIMS Summary Score. Enter Score Add scores for questions C0200-C0400 and fill in total score (00-15)
Enter 99 if the patient was unable to complete the interview.
The clinician will add up the first digit of each question to calculate the patient's BMIS score. The numeric value can be interpreted as follows:
- 13 to 15 points: intact cognition
- 8 to 12 points: moderately impaired cognition
- 0-7 points: severely impaired cognition
C1310. Signs and Symptoms of Delirium
After completing C0500 the clinician will move on to C1310.
A. Acute Onset of Mental Status Change. Is there evidence of an acute change in mental status from the patient's baseline?
0. No
1. Yes
B. Inattention. Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said?
0. Behavior not present
1. Behavior continuously present, does not fluctuate
2. Behavior present, fluctuates (comes and goes, changes in severity)
C. Disorganized thinking. Was the patient's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?
0. Behavior not present
1. Behavior continuously present, does not fluctuate
2. Behavior present, fluctuates (comes and goes, changes in severity)
D. Altered level of consciousness. Did the patient have altered level of consciousness, as indicated by any of the following criteria?
- vigilant – startled easily to any sound or touch
- lethargic – repeatedly dozed off when being asked questions, but responded to voice or touch
- stuporous – very difficult to arouse and keep aroused for the interview
- comatose – could not be aroused
0. Behavior not present
1. Behavior continuously present, does not fluctuate
2. Behavior present, fluctuates (comes and goes, changes in severity)
