HOPE Guidance Manual v1.02, Item J2040

Timepoint(s) Item Completed

Admission (ADM)

Item-Specific Instructions

• Item completion should be based on what is determined during the assessment visit and/or included in

the clinical record. Do not use sources external to the clinical record.

• Review the clinical record for information regarding treatment for shortness of breath.

• Review all response choices before making a selection.

A. Was treatment for shortness of breath initiated?

• Code 0, No, if treatment for shortness of breath was not initiated or offered and/or there is no

documentation that treatment for shortness of breath was initiated or offered. Skip to J2050, Symptom

Impact Screening.

• Code 1, No, patient declined treatment, if the patient declined treatment for shortness of breath

that was offered and/or there is documentation that the hospice offered treatment for shortness of breath,

but the patient or responsible party declined. Skip to J2050, Symptom Impact Screening.

• Code 2, Yes, if treatment for shortness of breath was initiated and/or there is documentation that

treatment for shortness of breath was initiated.

B. Date treatment for shortness of breath initiated:

• Enter the date the hospice-initiated treatment for shortness of breath.

• For non-medication interventions (for example, fans, positioning, patient education efforts) there will

not be any orders; in this case, use the date on which the hospice first discussed the intervention with the

patient/caregiver.

• If the patient received multiple types of treatment for shortness of breath (for example, oxygen and

education about positioning), enter the date that the first treatment was initiated.

• For pharmacologic interventions, treatment is considered initiated when the hospice has received the

order and there is documentation that the patient/caregiver was instructed to begin use of the medication

or treatment.

o An order may be verbal (when permitted) or written.

o Responses for this item should be based on whichever was used to determine the start of treatment.

 Enter the date of the order, irrespective of if/when the first dose was given. For orders continued

from previous care settings, the hospice must receive a new order to continue the treatment.

 Once this order is received, the date the hospice received the order is entered in J2040B.

• For comfort kits or pre-printed admission orders,

o Proactive education on medications in a comfort kit in anticipation of symptoms is not considered

initiation.

o Code based on when the order was both received and initiated.

o If the date the hospice received the order is different than the date the hospice instructed the

patient/caregiver to begin using the treatment/medication, “date treatment initiated” would be the

date, when both conditions were met (that is, the date the hospice received the order and instructed

patient/caregiver to begin use).

Coding Tips

• When reviewing the clinical record for treatments initiated for shortness of breath:

o Include both non-pharmacologic and pharmacologic treatment suggestions or measures.

o Include both scheduled and PRN treatments for shortness of breath.

• Some treatments have multiple uses. For example, opioids can be used to treat pain or shortness of

breath and relaxation techniques can be used to help with shortness of breath or anxiety.

o Only include such treatments in J2040 if the clinical record indicates that the intended purpose of the

treatment is to address the patient’s shortness of breath.

o Orders that contain multiple purposes for the medication are acceptable as long as one of the stated

purposes is to address shortness of breath.

Examples

1. Clinical documentation dated 10-06-2025 shows, “dyspnea/shortness of breath at rest, clinical signs

indicate patient is short of breath. Patient/family instructed on energy conservation techniques to

alleviate shortness of breath.” There is also an order dated 10-06-2025 showing, “morphine 10 mg PO

every four hours as needed.”

Coding: J2040A: Was treatment for shortness of breath initiated? Select response “2, Yes.” J2040B:

Date treatment for shortness of breath initiated: Enter “10-06-2025.”

Rationale: Documentation in the clinical record clearly indicates that the patient was short of breath

and that treatment was initiated for shortness of breath (energy conservation techniques). The morphine

listed in the order cannot be deemed treatment for shortness of breath because there is no indication

listed in the clinical record that the morphine was prescribed to treat shortness of breath. To be

considered a treatment for shortness of breath, the order would need to read “morphine 10 mg PO every

four hours as needed for shortness of breath.”

2. Clinical documentation dated 10-15-2025 shows, “dyspnea/shortness of breath at rest. Instructed family

to keep patient’s head elevated on pillows while patient is in bed.” Order dated 10-16-2025 shows,

“oxygen ordered and scopolamine to dry respiratory secretions.”

Coding: J2040A: Was treatment for shortness of breath initiated? Select response “2, Yes.” J2040B:

Date treatment for shortness of breath initiated: Enter “10-15-2025.”

Rationale: Documentation in the clinical record clearly indicates that the patient was short of breath

and that more than one treatment was initiated for shortness of breath. The date that the first treatment

for shortness of breath is initiated (10-15-2025, education about positioning) is the proper date to list in

Item J2040B.

3. Clinical documentation dated 12-28-2025 shows, “comfort kit in patient’s home and on stand-by.”

Documentation states, “patient and family were educated on what medications were in the comfort kit,

what symptoms the medications might be used for (including shortness of breath), and where to store

the kit until needed. Patient and family instructed not to use the medications in the comfort kit until

specifically advised to do so.”

Coding: J2040A: Was treatment for shortness of breath initiated? Select response “0, No.” Skip to Item

J2050, Symptom Impact Screening. J2040B: Date treatment for shortness of breath initiated: Do not

complete.

Rationale: Documentation in the clinical record indicates that the comfort kit included treatments that

could be used for shortness of breath, and that the nurse provided proactive education to the

patient/family about the availability of such treatments.

Documentation in the clinical record does not indicate that the nurse instructed the patient/family to

begin using any of the treatments for shortness of breath. Thus, for the purposes of completing Item

J2040, treatment for shortness of breath was not initiated.