Crosswalk

HIS V.3 Change Table
Key:
AD: Admission
DC: Discharge
#

Admission/
Discharge

Item / Text
Affected

1.

Discharge
(DC)

O5000

2.

Discharge
(DC)

O5010

3.

Discharge
(DC)

O5020

HIS V.2

HIS V.3

Rationale for
Change / Comments

Level of Care in final 3 days
Complete only if A2115. Reason for Discharge –
01 Expired
Did the patient receive Continuous Home Care,
General Inpatient Care, or Respite Care during
any of the final 3 days of life?
0. No
1. Yes, skip to Z0400, Signature(s) of
Person(s) Completing the Record
Number of hospice visits in final 3 days
Enter the number of visits provided by hospice
staff from the indicated discipline on each date
as indicated.
Staff 1. Visits on Day of Death (A0270) 2. Visits
one day per death (A0270 minus 1) 3. Visits
two days prior to death (A0270 minus 2)
A. Registered Nurse
B. Physician ( or Nurse Practitioner or Physician
Assistant)
C. Medical Social Worker
D. Chaplain or Spiritual Counselor
E. Licensed Practical Nurse
Aide

Reduction in burden. Proposed
HVLDL measure will use claims
data instead.

Level of care in final 7 days
Complete only if A2115, Reason for Discharge=
01 Expire
Did the patient receive Continuous Home Care,
General Inpatient Care, or Respite Care during
any of the final 7 days of life?
0. No
1. Yes, skip to Z0400, Signature(s) of Person(s)
Completing the Record

Reduction in burden. Proposed
HVLDL measure will use claims
data instead.

Reduction in burden. Proposed
HVLDL measure will use claims
data instead.

Page 1 of 2

HIS V.3 Change Table
Key:
AD: Admission
DC: Discharge
#

4.

Admission/
Discharge
Discharge
O
(DC)

Item / Text
Affected
O5030

HIS V.2

Number of hospice visits in 3 to 6 days prior to
death
Enter the number of visits provided by hospice
staff from the indicated discipline, on each of
the dates indicated
Visits three days prior to death (A0270 minus 3)
Visits four days prior to death (A0270 minus 4)
Visits five days prior to death ( A0270 minus 5)
Visits six days prior to death (A0270 minus 6)
A. Registered Nurse
B. Physician ( or Nurse Practitioner or Physician
Assistant)
C. Medical Social Worker
D. Chaplain or Spiritual Counselor
E. Licensed Practical Nurse
F. Aide

HIS V.3

Rationale for
Change / Comments
Reduction in burden. Proposed
HVLDL measure will use claims
data instead.

Page 2 of 2