CMS-10545 - Itemized List of Data Elements

Attachment C: Itemized List of OASIS Data Elements
Item

Description

M0010
M0014
M0016
M0018
M0020
M0030
M0032
M0040
M0050
M0060
M0063
M0064
M0065
M0066
M0069
M0080
M0090
M0100

CMS Certification Number
Branch State
Branch ID Number
National Provider Identifier (NPI)
Patient ID Number
Start of Care Date
Resumption of Care Date
Patient Name
Patient State of Residence
Patient ZIP Code
Medicare Number
Social Security Number
Medicaid Number
Birth Date
Gender
Discipline of Person Completing Assessment
Date Assessment Completed
This Assessment is Currently Being Completed for the Following
Reason
Date of Physician-ordered Start of Care (Resumption of Care)
Date of Referral
Episode Timing
Race/Ethnicity
Current Payment Sources for Home Care
Discharge/Transfer/ Death Date
Inpatient Facilities
Inpatient Discharge Date

M0102
M0104
M0110
M0140
M0150
M0906
M1000
M1005

Number of Data
Elements
1
1
1
1
1
1
1
3
1
1
1
1
1
1
1
1
1
1

SOC

1
1
1
1
8
1
7
1

1
1
1
1
8

ROC

FU

TOC

DTH

DIS

1
1
1

1
1
1

1
1
1

1
1
1

1
1
1

1
1
1

1

1

1

1

1
1
1
1
1
1

1
3
1
1
1
1
1
1
1
1
1
1

7
1

7
1

Item

Description

M1021
M1023
M1028
M1030
M1033
M1041
M1046
M1051
M1056
M1060
M1100
M1200
M1242

M1307

Primary Diagnosis, ICD-10-CM and Symptom Control Rating
Other Diagnoses, ICD-10-CM and Symptom Control Rating
Active Diagnoses – Comorbidities and Co-existing Conditions
Therapies patient receives at home
Risk for Hospitalization
Influenza Vaccine Data Collection Period
Influenza Vaccine Received
Pneumococcal Vaccine
Reason Pneumococcal Vaccine not received
Height and Weight
Patient Living Situation
Vision
Frequency of Pain Interfering with patient's activity or
movement
Does this patient have at least one Unhealed Pressure Ulcer at
Stage 2 or Higher or designated as Unstageable
The Oldest Stage 2 Pressure Ulcer that is present at discharge

M1311

Current Number of Unhealed Pressure Ulcers at Each Stage

12

12

12

12

M1322

Current Number of Stage 1 Pressure Ulcers

1

1

1

1

M1324

Stage of Most Problematic Unhealed Pressure Ulcer that is
Stageable
Does this patient have a Stasis Ulcer?
Current Number of Stasis Ulcer(s) that are Observable
Status of Most Problematic Stasis Ulcer that is Observable
Does this patient have a Surgical Wound?
Status of Most Problematic Surgical Wound that is Observable
When is the patient dyspneic or noticeably Short of Breath?
Has this patient been treated for a Urinary Tract Infection in the
past 14 days?
Urinary Incontinence or Urinary Catheter Presence

1

1

1

1

1

1
1
1
1
1
1
1

1
1
1
1
1
1
1

1
1
1
1
1
1
1

1
1
1
1
1
1

1

1

1

1

1

M1306

M1330
M1332
M1334
M1340
M1342
M1400
M1600
M1610

Number of Data
Elements
6
6
2
3
9
1
1
1
1
2
1
1
1

SOC

ROC

FU

TOC

DTH

DIS

6
6
2
3
9

6
6
2
3
9

6
6

2
1
1
1

2
1
1
1

1
1

1

1

1

1

1

1

3
9
1
1
1
1

1

1
1
1
1

1
12

1
1
1
1
1

Item

Description

Number of Data
Elements
1
1
1
1

SOC

ROC

FU

M1620
M1630
M1700
M1710

Bowel Incontinence Frequency
Ostomy for Bowel Elimination
Cognitive Functioning
When Confused (Reported or Observed Within the Last 14 Days)

M1720
M1730
M1740

1
1
1
1

1
1
1
1

1
1

When Anxious (Reported or Observed Within the Last 14 Days)
Depression Screening

1
3

1
3

1
3

1

6

6

6

6

1

1

1

1

1
1
1
1

1
1
1
1

1
1
1
1

1
1
1
1

1
1
1
1

M1840
M1845
M1850
M1860
M1870
M1910
M2001
M2003
M2005

Cognitive, behavioral, and psychiatric symptoms that are
demonstrated at least once a week (Reported or Observed)
Frequency of Disruptive Behavior Symptoms (Reported or
Observed)
Grooming
Ability to Dress Upper Body
Ability to Dress Lower Body
Bathing: Excludes grooming (washing face, washing hands, and
shampooing hair).
Toilet Transferring
Toileting Hygiene
Transferring
Ambulation/Locomotion
Feeding or Eating
Falls Risk Assessment
Drug Regimen Review
Medication Follow-up
Medication Intervention

1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1

1

1
1
1
1
1

M2010
M2016

Patient/Caregiver High-Risk Drug Education
Patient/Caregiver Drug Education Intervention

1
1

1

M2020

Management of Oral Medications: Excludes injectable and IV
medications.
Management of Injectable
Medications: Excludes IV medications

1

1

1

1

1

1

M1745
M1800
M1810
M1820
M1830

M2030

TOC

DTH

DIS
1
1
1

1
1

1

1

1

1
1

1
1

1

Item

Description

Number of Data
Elements
1

SOC

ROC

M2102

Types and Sources of Assistance

M2110

FU

TOC

DTH

DIS

1

1

1

1

1

M2200

How Often does the patient receive ADL or IADL assistance from
any caregiver(s) (other than home health agency staff)?
Therapy Need (# visits)

1

1

1

M2301

Emergent Care

1

1

1

M2310

Reason for Emergent Care

4

4

4

M2401

Intervention Synopsis

6

6

6

M2410

To which Inpatient Facility has the patient been admitted?

1

1

1

M2420

Discharge Disposition

1

GG 0170A

Roll left and right

1

1

1

1

1

GG 0170B

Sit to lying

1

1

1

1

1

GG0170C

Mobility – Lying to sitting on side of bed

1

1

1

GG 0170C

Lying to sitting

1

1

1

GG 0170D

Sit to stand

1

1

1

1

1

GG 0170E

Chair/bed-to-chair transfer

1

1

1

1

1

GG 0170F

Toilet transfer

1

1

1

1

1

GG 0170J

Walk 50 feet with 2 turns

1

1

1

1

1

GG 0170K

Walk 150 feet

1

1

1

GG 0170Q

Wheelchair?

1

1

1

1

1

GG 0170R

Wheel 50 feet with two turns

1

1

1

1

1

GG 0170RR

Type of WC

1

1

1

1

GG 0170S

Wheel 150 feet

1

1

1

1

GG 0170RR

Type of WC

1

1

1

1

GG 0130A

Eating

1

1

1

1

1

GG 0130B

Oral hygiene

1

1

1

1

1

GG 0130C

Toilet hygiene

1

1

1

1

1

1

1

1

1

Item

Description

Number of Data
Elements
1

SOC

ROC

GG Goal

Goal (at least 1)

GG 0170G

1

1

Car transfer

1

1

1

GG 0170I

Walk 10 feet

1

1

1

1

1

GG 0170L

Walking 10 feet on uneven surfaces

1

1

1

1

1

GG 1070M

1 step

1

1

1

1

1

GG 0170N

4 steps

1

1

1

1

1

GG 0170O

12 steps

1

1

1

1

GG 0170P

Pick up object

1

1

1

1

GG 0130E

Shower/bathe self

1

1

1

1

GG 0130F

Upper body dressing

1

1

1

1

GG 0130G

Lower body dressing

1

1

1

1

GG 0130H

Putting on/taking off footwear

1

1

1

1

GG0100A

Prior Function

1

1

1

GG0100B

Prior Function

1

1

1

GG0100C

Prior Function

1

1

1

GG0100D

Prior Function

1

1

1

GG0110

Prior Device Use (A-E, Z)

1

1

1

J1800

Falls?

1

J1900

Injury #
Total number of Data Elements

Total minutes per assessment (.3 minutes per data element)

3
177
53.1

159
47.7

135
40.5

FU

TOC

DTH

DIS

1

79
23.7

1

1

1

3
26
7.8

3

3
98
29.4

9
2.7