Attachment C_ OASIS-E2 Itemized List of Data Elements 508

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

M0018

National Provider Identifier (NPI)

X

M0010

CMS Certification Number

X

M0014

Branch State

X

M0016

Branch ID Number

X

M0020

Patient ID Number

X

M0030

Start of Care Date

X

M0032

Resumption of Care Date

M0040

Patient Name

X

M0050

Patient State of Residence

X

M0060

Patient ZIP Code

X

M0064

Social Security Number

X

M0063

Medicare Number

X

M0065

Medicaid Number

X

A0810

Sex

X

M0066

Birth Date

X

ROC

FU

TOC

DAH

DC

X

1

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

A1005

Ethnicity

X

A1010

Race

X

M0150

Current Payment Sources for Home Care

X

A1110

Language

X

X

M0080

Discipline of Person Completing Assessment

X

X

M0090

Date Assessment Completed

X

M0100

This Assessment is Currently Being Completed for the
Following Reason

X

M0906

Discharge/Transfer/ Death Date

M0102

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

X

X

M0104

Date of Referral

X

X

A1255

Transportation

X

X

M1000

Inpatient Facilities from which the patient was
discharged within the past 14 days?

X

X

M1005

Inpatient Discharge Date

X

X

M2301

Emergent Care

FU

TOC

DAH

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

DC

X
2

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

TOC

DAH

DC

M2310

Reason for Emergent Care

X

X

M2410

To which Inpatient Facility has the patient been admitted?

X

X

M2420

Discharge Disposition

A2120

Provision of Current Reconciled Medication List to
Subsequent Provider at Transfer

A2121

Provision of Current Reconciled Medication List to
Subsequent Provider at Discharge

A2122

Route of Current Reconciled Medication List
Transmission to Subsequent Provider

A2123

Provision of Current Reconciled Medication List to
Patient at Discharge

X

A2124

Route of Current Reconciled Medication List to
Transmission to Patient

X

B0200

Hearing

X

X

B1000

Vision

X

X

B1300

Health Literacy

X

X

X

C0100

Should Brief Interview for Mental Status (C0200C0500) be Conducted?

X

X

X

X
X
X
X

X

3

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

C0200

Repetition of Three Words

X

X

X

C0300

Temporal Orientation

X

X

X

C0400

Recall

X

X

X

C0500

BIMS Summary Score

X

X

X

C1310

Signs and Symptoms of Delirium (from CAM©)

X

X

X

M1700

Cognitive Functioning

X

X

X

X

X

X

X

X

X

M1710
M1720

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

ROC

FU

TOC

DAH

DC

D0150

Patient Mood Interview (PHQ-2 to 9)

X

X

X

D0160

Total Severity Score

X

X

X

D0700

Social Isolation

X

X

X

M1740

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

X

X

X

M1745

Frequency of Disruptive Behavior Symptoms
(Reported or Observed)

X

X

M1100

Patient Living Situation

X

X

X

4

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

TOC

DAH

DC

M2102

Types and Sources of Assistance

X

X

M1800

Grooming

X

X

X

X

M1810

Current Ability to Dress Upper Body

X

X

X

X

M1820

Current Ability to Dress Lower Body

X

X

X

X

M1830

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

X

X

X

X

M1840

Toilet Transferring

X

X

X

X

M1845

Toileting Hygiene

M1850

Transferring

X

X

X

X

M1860

Ambulation/Locomotion

X

X

X

X

GG 0100

Prior Functioning: Everyday Activities

X

X

GG 0110

Prior Device Use

X

X

GG 0130A

Eating

X

X

X

X

GG 0130B

Oral hygiene

X

X

X

X

GG 0130C

Toilet hygiene

X

X

X

X

GG 0130E

Shower/bathe self

X

X

X

X

X

X
5

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

TOC

DAH

DC

GG 0130F

Upper body dressing

X

X

X

GG 0130G

Lower body dressing

X

X

X

GG 0130H

Putting on/taking off footwear

X

X

X

GG 0170A

Roll left and right

X

X

X

X

GG 0170B

Sit to lying

X

X

X

X

GG 0170C

Lying to sitting

X

X

X

X

GG 0170D

Sit to stand

X

X

X

X

GG 0170E

Chair/bed-to-chair transfer

X

X

X

X

GG 0170F

Toilet transfer

X

X

X

X

GG 0170G

Car transfer

X

X

GG 0170I

Walk 10 feet

X

X

X

X

GG 0170J

Walk 50 feet with two turns

X

X

X

X

GG 0170K

Walk 150 feet

X

X

GG 0170L

Walking 10 feet on uneven surfaces

X

X

X

X

GG 1070M

1 step (curb)

X

X

X

X

GG 0170N

4 steps

X

X

X

X

X

X

6

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

TOC

DAH

DC

GG 0170O

12 steps

X

X

X

GG 0170P

Picking up object

X

X

X

GG 0170Q

Does patient use wheelchair and/or scooter?

X

X

X

X

GG 0170R

Wheel 50 feet with two turns

X

X

X

X

GG 0170RR

Type of wheelchair or scooter

X

X

X

GG 0170S

Wheel 150 feet

X

X

X

GG 0170SS1 Type of wheelchair or scooter

X

X

X
X

M1600

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

X

X

M1610

Urinary Incontinence or Urinary Catheter Presence

X

X

M1620

Bowel Incontinence Frequency

X

X

M1630

Ostomy for Bowel Elimination

X

X

M1021

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

X

X

M1023

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

X

X

M1028

Active Diagnoses – Comorbidities and Co-existing Conditions

X

X

M1033

Risk for Hospitalization

X

X

X

X
7

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

J0510

PAIN: Pain Effect on sleep

X

X

X

J0520

PAIN: Pain Interference with therapy activities

X

X

X

J0530

PAIN: Pain Interference with day-to-day activities

X

X

X

J1800

Any Falls Since SOC/ROC

X

X

X

J1900

Number of Falls Since SOC/ROC

X

X

X

M1400

When is the patient dyspneic or short of breath?

X

X

X

M1060

Height and Weight

X

X

X

K0520A

NUTRITION: Parenteral/IV feeding

X

X

X

K0520B

NUTRITION: Feeding tube

X

X

X

K0520C

NUTRITION: Mechanically altered diet

X

X

X

K0520D

NUTRITION: Therapeutic diet

X

X

X

K0520Z

NUTRITION: None of the above

X

X

X

M1870

Feeding or Eating

X

X

X

M1306

Unhealed Pressure Ulcer at Stage 2 or Higher or
designated as Unstageable

X

X

M1307

The Oldest Stage 2 Pressure Ulcer that is present at discharge

X

TOC

DAH

DC

X
X
8

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

TOC

DAH

DC

M1311

Current Number of Unhealed Pressure Ulcers at Each Stage

X

X

M1322

Current Number of Stage 1 Pressure Ulcers

X

X

M1324

Stage of Most Problematic Unhealed Pressure Ulcer
that is Stageable

X

X

X

M1330

Does this patient have a Stasis Ulcer?

X

X

X

M1332

Current Number of Stasis Ulcer(s) that are Observable

X

X

M1334

Status of Most Problematic Stasis Ulcer that is Observable

X

X

X

M1340

Does this patient have a Surgical Wound?

X

X

X

M1342

Status of Most Problematic Surgical Wound that is
Observable

X

X

X

N0415A

HIGH RISK DRUGS: Antipsychotic

X

X

X

N0415E

HIGH RISK DRUGS: Anticoagulant

X

X

X

N0415F

HIGH RISK DRUGS: Antibiotic

X

X

X

N0415H

HIGH RISK DRUGS: Opioid

X

X

X

N0415I

HIGH RISK DRUGS: Antiplatelet

X

X

X

N0415J

HIGH RISK DRUGS: Hypoglycemic (including insulin)

X

X

X

N0415Z

HIGH RISK DRUGS: None of the above

X

X

X

X

9

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

TOC

M2001

Drug Regimen Review

X

X

M2003

Medication Follow-up

X

X

M2005

Medication Intervention

M2010

Patient/Caregiver High-Risk Drug Education

X

X

M2020

Management of Oral Medications: Excludes
injectable and IV medications.

X

X

X

M2030

Management of Injectable Medications: Excludes IV
medications

X

X

X

O0110A

Chemotherapy and child items

X

X

X

O0110B

Radiation

X

X

X

O0110C

Oxygen therapy and child items

X

X

X

O0110D

Suctioning and child items

X

X

X

O0110E

Tracheostomy care

X

X

X

O0110F

Invasive mechanical ventilation

X

X

X

O0110G

Non-invasive mechanical vent and child items

X

X

X

O0110H

IV medications and child items

X

X

X

O0110I

Transfusions

X

X

X

X

DAH

DC

X

X

10

Attachment C. OASIS-E2 Itemized List of Data Elements

Item

Description

SOC

ROC

FU

TOC

DAH

DC

O0110J

Dialysis and child items

X

X

X

O0110O

IV access and child items

X

X

X

O0110Z

None of the above

X

X

X

M1041

Influenza Vaccine Data Collection Period

X

X

M1046

Influenza Vaccine Received

X

X

M2401

Intervention Synopsis

X

X

11