CMS-10545 - Itemized List of Data Elements

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
M0018

National Provider Identifier (NPI)

1

1

0

0

0

0

0

M0010

CMS Certification Number

1

1

0

0

0

0

0

M0014

Branch State

1

1

0

0

0

0

0

M0016

Branch ID Number

1

1

0

0

0

0

0

M0020

Patient ID Number

1

1

0

0

0

0

0

M0040

Patient Name

1

1

0

0

0

0

0

M0050

Patient State of Residence

1

1

0

0

0

0

0

M0060

Patient ZIP Code

1

1

0

0

0

0

0

M0064

Social Security Number

1

1

0

0

0

0

0

M0063

Medicare Number

1

1

0

0

0

0

0

M0065

Medicaid Number

1

1

0

0

0

0

0

M0069

Gender

1

1

0

0

0

0

0

M0066

Birth Date

1

1

0

0

0

0

0

A1005

Ethnicity

1

1

0

0

A1010

Race

6

6

0

0

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1

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

0

0

0

0

Elements
M0150

Current Payment Sources for Home Care

8

8

0

A1110

Language

1

1

0

M0030

Start of Care Date

1

1

M0032

Resumption of Care Date

1

M0080

Discipline of Person Completing Assessment

1

1

1

1

1

1

1

M0090

Date Assessment Completed

1

1

1

1

1

1

1

M0100

This Assessment is Currently Being Completed for the Following
Reason

1

1

1

1

1

1

1

M0906

Discharge/Transfer/ Death Date

1

1

1

1

M0102

Date of Physician-ordered Start of Care (Resumption of Care)

1

1

1

M0104

Date of Referral

1

1

1

M0110

Episode Timing

1

1

1

A1250

Transportation

1

1

1

M1000

From which of the following Inpatient Facilities was the patient
discharged within the past 14 days?

7

7

7

M1005

Inpatient Discharge Date

1

1

1

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0

1

1
1

2

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
M2301

Emergent Care

1

1

1

M2310

Reason for Emergent Care

3

3

3

M2410

To which Inpatient Facility has the patient been admitted?

1

1

1

M2420

Discharge Disposition

1

A2120

Provision of Current Reconciled Medication List to Subsequent
Provider at Transfer

1

A2121

Provision of Current Reconciled Medication List to Subsequent
Provider at Discharge

1

1

A2123

Provision of Current Reconciled Medication List to Patient at
Discharge

1

1

A2122

Route of Current Reconciled Medication List Transmission to
Subsequent Provider

0

A2124

Route of Current Reconciled Medication List to Transmission to
Patient

0

B0200

Hearing

1

1

0

0

B1000

Vision

1

1

0

0

B1300

Health Literacy

1

1

1

1

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1
1

0
0

3

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
C0100

Should Brief Interview for Mental Status (C0200-C0500) be
Conducted?

1

1

1

1

C0200

Repetition of Three Words

1

1

1

1

C0300

Temporal Orientation

3

3

3

3

C0400

Recall

3

3

3

3

C0500

BIMS Summary Score

1

1

1

1

C1310

Signs and Symptoms of Delirium (from CAM©)

4

4

4

4

M1700

Cognitive Functioning

1

1

1

1

M1710

When Confused (Reported or Observed Within the Last 14 Days)

1

1

1

1

M1720

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

1

1

1

1

D0150

Patient Mood Interview PHQ-2 to 9

9

9

9

9

D0160

Total Severity Score

0

0

0

0

D0700

Social Isolation

1

1

1

1

M1740

Cognitive, behavioral, and psychiatric symptoms that are
demonstrated at least once a week (Reported or Observed)

6

6

6

6

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Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
M1745

Frequency of Disruptive Behavior Symptoms (Reported or
Observed)

1

1

1

M1100

Patient Living Situation

1

1

1

M2102

Types and Sources of Assistance

4

1

1

M1800

Grooming

1

1

1

1

1

M1810

Ability to Dress Upper Body

1

1

1

1

1

M1820

Ability to Dress Lower Body

1

1

1

1

1

M1830

Bathing: Excludes grooming (washing face, washing hands, and
shampooing hair).

1

1

1

1

1

M1840

Toilet Transferring

1

1

1

1

1

M1845

Toileting Hygiene

1

1

1

M1850

Transferring

1

1

1

1

1

M1860

Ambulation/Locomotion

1

1

1

1

1

GG0100

Prior Functioning: Everyday Activities

4

4

4

GG0110

Prior Device Use

5

5

5

GG 0130A

Eating

1

1

1

1

1

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1

4

1

5

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
GG 0130B

Oral hygiene

1

1

1

1

1

GG 0130C

Toilet hygiene

1

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

GG 0170A

Roll left and right

1

1

1

1

1

GG 0170B

Sit to lying

1

1

1

1

1

GG 0170C

Lying to sitting

1

1

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 0170G

Car transfer

1

1

1

GG 0170I

Walk 10 feet

1

1

1

1

1

GG 0170J

Walk 50 feet with 2 turns

1

1

1

1

1

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6

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
GG 0170K

Walk 150 feet

1

1

1

GG 0170L

Walking 10 feet on uneven surfaces

1

1

1

1

1

GG 1070M

1 step (curb)

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 0170Q

Does patient use wheelchair and/or scooter?

1

1

1

1

1

GG 0170R

Wheel 50 feet with two turns

1

1

1

1

1

GG 0170RR

Type of wheelchair or scooter

1

1

1

1

GG 0170S

Wheel 150 feet

1

1

1

1

GG 0170SS

Type of wheelchair or scooter

1

1

1

1

GG Goal

Goal (at least 1)

1

1

1

M1600

Has this patient been treated for a Urinary Tract Infection in the
past 14 days?

1

1

1

M1610

Urinary Incontinence or Urinary Catheter Presence

1

1

1

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1

1

7

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
M1620

Bowel Incontinence Frequency

1

1

1

M1630

Ostomy for Bowel Elimination

1

1

1

M1028

Active Diagnoses – Comorbidities and Co-existing Conditions

2

2

2

M1021

Primary Diagnosis, ICD-10-CM and Symptom Control Rating

2

2

2

M1023

Other Diagnosis, ICD-10-CM and Symptom Control Rating

10

10

10

M1033

Risk for Hospitalization

9

9

9

J0510

PAIN: Pain Effect on sleep

1

1

1

1

J0520

PAIN: Pain Interference with therapy

1

1

1

1

J0530

PAIN: Pain Interference with activities (replace M1242)

1

1

1

1

J1800

Any Falls Since SOC/ROC

1

1

1

1

J1900

Number of Falls Since SOC/ROC

3

3

3

3

M1400

When is the patient dyspneic or noticeably Short of Breath?

1

1

1

M1060

Height and Weight

2

2

2

K0520A

NUTRITION: Parenteral/IV feeding

1

1

1

1

K0520B

NUTRITION: Feeding tube

1

1

1

1

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1

9

1

8

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
K0520C

NUTRITION: Mechanically altered diet

1

1

1

1

K0520D

NUTRITION: Therapeutic diet

1

1

1

1

K0520Z

NUTRITION: None of the above

0

0

0

0

M1870

Feeding or Eating

1

1

1

1

M1306

Does this patient have at least one Unhealed Pressure Ulcer at
Stage 2 or Higher or designated as Unstageable

1

1

1

M1307

The Oldest Stage 2 Pressure Ulcer that is present at discharge

1

M1311

Current Number of Unhealed Pressure Ulcers at Each Stage

12

6

6

M1322

Current Number of Stage 1 Pressure Ulcers

1

1

1

M1324

Stage of Most Problematic Unhealed Pressure Ulcer that is
Stageable

1

1

1

1

M1330

Does this patient have a Stasis Ulcer?

1

1

1

1

M1332

Current Number of Stasis Ulcer(s) that are Observable

1

1

1

M1334

Status of Most Problematic Stasis Ulcer that is Observable

1

1

1

1

M1340

Does this patient have a Surgical Wound?

1

1

1

1

M1342

Status of Most Problematic Surgical Wound that is Observable

1

1

1

1

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1

1
1
12

0

9

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
N0415A

HIGH RISK DRUGS: Antipsychotic

1

1

1

1

N0415E

HIGH RISK DRUGS: Anticoagulant

1

1

1

1

N0415F

HIGH RISK DRUGS: Antibiotic

1

1

1

1

N0415H

HIGH RISK DRUGS: Opioid

1

1

1

1

N0415I

HIGH RISK DRUGS: Antiplatelet

1

1

1

1

N0415J

HIGH RISK DRUGS: Hypoglycemic (including insulin)

1

1

1

1

N0415Z

HIGH RISK DRUGS: None of the above

0

0

0

0

M2001

Drug Regimen Review

1

1

1

M2003

Medication Follow-up

1

1

1

M2005

Medication Intervention

1

M2010

Patient/Caregiver High-Risk Drug Education

1

1

1

M2020

Management of Oral Medications: Excludes injectable and IV
medications.

1

1

1

M2030

Management of Injectable Medications: Excludes IV medications

1

1

1

O0110A

Chemotherapy and child items

1

1

1

Attachment C
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1

1

1

1

1

10

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

Elements
O0110B

Radiation

1

1

1

1

O0110C

Oxygen therapy and child items

1

1

1

1

O0110D

Suctioning and child items

1

1

1

1

O0110E

Tracheostomy care

1

1

1

1

O0110F

Invasive mechanical ventilation

1

1

1

1

O0110G

Non-invasive mechanical vent and child items

1

1

1

1

O0110H

IV medications and child items

1

1

1

1

O0110I

Transfusions

1

1

1

1

O0110J

Dialysis and child items

1

1

1

1

O0110O

IV access and child items

1

1

1

1

O0110Z

None of the above

0

0

0

0

M1041

Influenza Vaccine Data Collection Period

1

1

1

M1046

Influenza Vaccine Received

1

1

1

M2200

Therapy Need (# visits)

1

M2401

Intervention Synopsis

5

5

5

Attachment C
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1

1

11

Itemized List of OASIS-E Data Elements
Item

Description

Number of Data

SOC

ROC

FU

TOC

DAH

DC

203

172

37

22

9

146

57.3

48

11.1

6.6

2.7

40.2

Elements
Total number of Data Elements
Total minutes per assessment (.15 - .3 minutes per data
element)

Attachment C
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249

12