Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. OASIS-C Items Mapping -- Model Of Use

12/01/2011

CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
PATIENT TRACKING          
M0010_CCN   CMS Certification Number   46456-0    
M0014_BRANCH_STATE   Branch State   46494-1    
M0016_BRANCH_ID   Branch ID (Optional)   46495-8    
M0018_PHYSICIAN_ID   Primary Referring Physician National Provider ID (NPI)   44954-6    
M0018_PHYSICIAN_UK   Primary Referring Physician NPI: Unknown        
M0020_PAT_ID   Patient ID Number   46496-6    
M0030_START_CARE_DT   Start of Care Date   46497-4    
M0032_ROC_DT   Resumption of Care Date   46498-2    
M0032_ROC_DT_NA NA No Resumption of Care Date        
M0040_PAT_FNAME   Patient's First Name   45392-8    
M0040_PAT_MI   Patient's Middle Initial   45393-6    
M0040_PAT_LNAME   Patient's Last Name   45394-4    
M0040_PAT_SUFFIX   Patient's Suffix   45395-1    
M0050_PAT_ST   Patient State of Residence   46499-0    
M0060_PAT_ZIP   Patient Zip Code   45401-7    
M0063_MEDICARE_NUM   Medicare Number, Including Suffix   45397-7    
M0063_MEDICARE_NA NA No Medicare Number        
M0064_SSN   Patient's Social Security Number   45396-9    
M0064_SSN_UK UK No Social Security Number        
M0065_MEDICAID_NUM   Medicaid Number   45400-9    
M0065_MEDICAID_NA NA No Medicaid Number        
M0066_PAT_BIRTH_DT   Date of Birth   21112-8    
M0069_PAT_GENDER   Gender   46607-8    
M0069_PAT_GENDER 1 Male   46607-8 LA2-8 1.3.6.1.4.1.12009.10.1.138
M0069_PAT_GENDER 2 Female   46607-8 LA3-6 1.3.6.1.4.1.12009.10.1.138
M0140_ETHNIC_AI_AN 1 Race/Ethnicity: American Indian or Alaska Native       2.16.840.1.113883.1.11.15836
M0140_ETHNIC_ASIAN 2 Race/Ethnicity: Asian       2.16.840.1.113883.1.11.15836
M0140_ETHNIC_BLACK 3 Race/Ethnicity: Black or African-American       2.16.840.1.113883.1.11.15836
M0140_ETHNIC_HISP 4 Race/Ethnicity: Hispanic or Latino       2.16.840.1.113883.1.11.15836
M0140_ETHNIC_NH_PI 5 Race/Ethnicity: Native Hawaiian or Pacific Islander       2.16.840.1.113883.1.11.15836
M0140_ETHNIC_WHITE 6 Race/Ethnicity: White       2.16.840.1.113883.1.11.15836
M0150   Current payment sources for home care Question row added to facilitate message format. 57199-2    
M0150_CPAY_NONE 0 Current Payment Sources for Home Care: None; no charge for current services   57199-2 LA12090-9 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_MCARE_FFS 1 Current Payment Sources for Home Care: Medicare Traditional Fee-for-Service   57199-2 LA6259-1 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_MCARE_HMO 2 Current Payment Sources for Home Care: Medicare HMO/Managed Care   57199-2 LA12092-5 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_MCAID_FFS 3 Current Payment Sources for Home Care: Medicaid Traditional Fee-for-Service   57199-2 LA6257-5 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_MCAID_HMO 4 Current Payment Sources for Home Care: Medicaid HMO/Managed Care   57199-2 LA6256-7 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_WRKCOMP 5 Current Payment Sources for Home Care: Worker's Compensation   57199-2 LA6452-2 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_TITLEPGMS 6 Current Payment Sources for Home Care: Title Programs   57199-2 LA6398-7 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_OTH_GOVT 7 Current Payment Sources for Home Care: Other Government   57199-2 LA10049-7 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_PRIV_INS 8 Current Payment Sources for Home Care: Private Insurance   57199-2 LA6350-8 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_PRIV_HMO 9 Current Payment Sources for Home Care: Private HMO/Managed Care   57199-2 LA6349-0 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_SELFPAY 10 Current Payment Sources for Home Care: Self-Pay   57199-2 LA6369-8 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_OTHER 11 Current Payment Sources for Home Care: Other This is handled in the CDA by making "Other" a null, and including the text response in the <originalText> field 57199-2 LA6310-2 1.3.6.1.4.1.12009.10.1.80
M0150_CPAY_UK UK Current Payment Sources for Home Care: Unknown   57199-2 LA4489-6 1.3.6.1.4.1.12009.10.1.80
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
CLINICAL RECORD ITEMS          
M0080_ASSESSOR_DISCIPLINE   Discipline of Person Completing Assessment   46500-5    
M0080_ASSESSOR_DISCIPLINE 1 RN   46500-5 LA6367-2 1.3.6.1.4.1.12009.10.1.139
M0080_ASSESSOR_DISCIPLINE 2 PT   46500-5 LA6353-2 1.3.6.1.4.1.12009.10.1.139
M0080_ASSESSOR_DISCIPLINE 3 SLP/ST   46500-5 LA6378-9 1.3.6.1.4.1.12009.10.1.139
M0080_ASSESSOR_DISCIPLINE 4 OT   46500-5 LA6309-4 1.3.6.1.4.1.12009.10.1.139
M0090_INFO_COMPLETED_DT   Date Assessment Completed   46501-3    
M0100_ASSMT_REASON   Reason for Assessment   57200-8    
M0100_ASSMT_REASON 1 Start of care - further visits planned   57200-8 LA6390-4 1.3.6.1.4.1.12009.10.1.78
M0100_ASSMT_REASON 3 Resumption of care (after inpatient stay)   57200-8 LA6366-4 1.3.6.1.4.1.12009.10.1.78
M0100_ASSMT_REASON 4 Recertification (follow-up) reassessment   57200-8 LA6355-7 1.3.6.1.4.1.12009.10.1.78
M0100_ASSMT_REASON 5 Other follow-up   57200-8 LA6312-8 1.3.6.1.4.1.12009.10.1.78
M0100_ASSMT_REASON 6 Transferred to an inpatient facility - patient not discharged from agency   57200-8 LA6402-7 1.3.6.1.4.1.12009.10.1.78
M0100_ASSMT_REASON 7 Transferred to an inpatient facility - patient discharged from agency   57200-8 LA6401-9 1.3.6.1.4.1.12009.10.1.78
M0100_ASSMT_REASON 8 Death at home   57200-8 LA6179-1 1.3.6.1.4.1.12009.10.1.78
M0100_ASSMT_REASON 9 Discharge from agency   57200-8 LA6184-1 1.3.6.1.4.1.12009.10.1.78
M0102_PHYSN_ORDRD_SOCROC_DT   Physician Ordered SOC/ROC Date   57201-6    
M0102_PHYSN_ORDRD_SOCROC_DT_NA NA Physician Ordered SOC/ROC Date - NA        
M0104_PHYSN_RFRL_DT   Physician Date Of Referral   57202-4    
M0110_EPISODE_TIMING   Episode Timing   57203-2    
M0110_EPISODE_TIMING 1 Early   1 LA12111-3 1.3.6.1.4.1.12009.10.1.79
M0110_EPISODE_TIMING 2 Later   2 LA12112-1 1.3.6.1.4.1.12009.10.1.79
M0110_EPISODE_TIMING NA Not applicable: No Medicare case mix group to be defined by this assessment.   NA LA12114-7 1.3.6.1.4.1.12009.10.1.79
M0110_EPISODE_TIMING UK Unknown   UK LA4489-6 1.3.6.1.4.1.12009.10.1.79
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
PATIENT HISTORY AND DIAGNOSES          
M1000   Inpatient discharge facility Question row added to facilitate message format. 57204-0    
M1000_DC_LTC_14_DA 1 Past 14 Days: Dschrgd From LTC NH   57204-0 LA12115-4 1.3.6.1.4.1.12009.10.1.81
M1000_DC_SNF_14_DA 2 Past 14 Days: Discharged from Skilled Nursing Facility   57204-0 LA10080-2 1.3.6.1.4.1.12009.10.1.81
M1000_DC_IPPS_14_DA 3 Past 14 Days: Dschrgd From Short Stay Acute Hospital   57204-0 LA12117-0 1.3.6.1.4.1.12009.10.1.81
M1000_DC_LTCH_14_DA 4 Past 14 Days: Dschrgd From Long Term Care Hospital   57204-0 LA10000-0 1.3.6.1.4.1.12009.10.1.81
M1000_DC_IRF_14_DA 5 Past 14 Days: Discharged From Inpatient Rehab Facility   57204-0 LA9986-6 1.3.6.1.4.1.12009.10.1.81
M1000_DC_PSYCH_14_DA 6 Past 14 Days: Dschrgd From Psychiatric Hospital Or Unit   57204-0 LA10065-3 1.3.6.1.4.1.12009.10.1.81
M1000_DC_OTH_14_DA 7 Past 14 Days: Dschrgd From Other This is handled in the CDA by making "Other" a null, and including the text response in the <originalText> field 57204-0 LA6310-2 1.3.6.1.4.1.12009.10.1.81
M1000_DC_NONE_14_DA N/A Past 14 Days: Not Discharged from Inpatient Facility   57204-0 LA6342-5 1.3.6.1.4.1.12009.10.1.81
M1005_INP_DISCHARGE_DT   Most Recent Inpatient Discharge Date   46503-9    
M1005_INP_DSCHG_UNKNOWN UK Inpatient Discharge Date Unknown        
M1010   Inpatient Diagnosis Question row added to facilitate message format.      
M1010_14_DAY_INP1_ICD a Inpatient Stay Within Last 14 Days: ICD Code 1   46504-7   2.16.840.1.113883.6.103
M1010_14_DAY_INP2_ICD b Inpatient Stay Within Last 14 Days: ICD Code 2   46504-7   2.16.840.1.113883.6.103
M1010_14_DAY_INP3_ICD c Inpatient Stay Within Last 14 Days: ICD Code 3   46504-7   2.16.840.1.113883.6.103
M1010_14_DAY_INP4_ICD d Inpatient Stay Within Last 14 Days: ICD Code 4   46504-7   2.16.840.1.113883.6.103
M1010_14_DAY_INP5_ICD e Inpatient Stay Within Last 14 Days: ICD Code 5   46504-7   2.16.840.1.113883.6.103
M1010_14_DAY_INP6_ICD f Inpatient Stay Within Last 14 Days: ICD Code 6   46504-7   2.16.840.1.113883.6.103
M1012   Inpatient Procedure Question row added to facilitate message format.      
M1012_INP_PRCDR1_ICD a Inpatient ICD Procedure1 Code   58050-6   2.16.840.1.113883.6.104
M1012_INP_PRCDR2_ICD b Inpatient ICD Procedure2 Code   58050-6   2.16.840.1.113883.6.104
M1012_INP_PRCDR3_ICD c Inpatient ICD Procedure3 Code   58050-6   2.16.840.1.113883.6.104
M1012_INP_PRCDR4_ICD d Inpatient ICD Procedure4 Code   58050-6   2.16.840.1.113883.6.104
M1012_INP_NA_ICD NA Inpatient ICD Procedure Code - NA   58050-6   2.16.840.1.113883.6.104
M1012_INP_UK_ICD UK Inpatient ICD Procedure Code - UK   58050-6   2.16.840.1.113883.6.104
M1016   Diagnosis Requiring Regimen Change Question row added to facilitate message format.      
M1016_CHGREG_ICD1 a Regimen Change in Past 14 Days: ICD Code 1   46507-0   2.16.840.1.113883.6.103
M1016_CHGREG_ICD2 b Regimen Change in Past 14 Days: ICD Code 2   46507-0   2.16.840.1.113883.6.103
M1016_CHGREG_ICD3 c Regimen Change in Past 14 Days: ICD Code 3   46507-0   2.16.840.1.113883.6.103
M1016_CHGREG_ICD4 d Regimen Change in Past 14 Days: ICD Code 4   46507-0   2.16.840.1.113883.6.103
M1016_CHGREG_ICD5 e Regimen Change In Past 14 Days: ICD Code 5   46507-0   2.16.840.1.113883.6.103
M1016_CHGREG_ICD6 f Regimen Change In Past 14 Days: ICD Code 6   46507-0   2.16.840.1.113883.6.103
M1016_CHGREG_ICD_NA NA Regimen Change In Past 14 Days: Not Applicable   46507-0   2.16.840.1.113883.6.103
M1018   Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days Question row added to facilitate message format. 46465-1    
M1018_PRIOR_UR_INCON 1 Prior Condition: Urinary Incontinence   46465-1 LA6436-5 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_CATH 2 Prior Condition: Indwelling/Suprapubic Catheter   46465-1 LA6240-1 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_INTRACT_PAIN 3 Prior Condition: Intractable Pain   46465-1 LA6243-5 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_IMPR_DECSN 4 Prior Condition: Impaired Decision-making   46465-1 LA6227-8 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_DISRUPTIVE 5 Prior Condition: Disruptive or Socially Inappropriate Behavior   46465-1 LA6186-6 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_MEM_LOSS 6 Prior Condition: Memory Loss, Supervision Required   46465-1 LA6261-7 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_NONE 7 Prior Condition: None of the Above   46465-1 LA9-3 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_NOCHG_14D NA Prior Condition: No Inpatient Discharge, No Change in Regimen in Past 14 Days   46465-1 LA6282-3 1.3.6.1.4.1.12009.10.1.140
M1018_PRIOR_UNKNOWN UK Prior Condition: Unknown   46465-1 LA4489-6 1.3.6.1.4.1.12009.10.1.140
M1020_PRIMARY_DIAG_ICD a Primary Diagnosis ICD Code   46511-2   2.16.840.1.113883.6.103
M1020_PRIMARY_DIAG_SEVERITY   Primary Diagnosis Severity Rating   46512-0    
M1020_PRIMARY_DIAG_SEVERITY 0 Asymptomatic, no treatment needed   46512-0 LA6111-4 1.3.6.1.4.1.12009.10.1.141
M1020_PRIMARY_DIAG_SEVERITY 1 Symptoms well controlled with current therapy   46512-0 LA6112-2 1.3.6.1.4.1.12009.10.1.141
M1020_PRIMARY_DIAG_SEVERITY 2 Symptoms controlled with difficulty   46512-0 LA6113-0 1.3.6.1.4.1.12009.10.1.141
M1020_PRIMARY_DIAG_SEVERITY 3 Symptoms poorly controlled; patient needs frequent adjustment in treatment & dose monitoring   46512-0 LA6114-8 1.3.6.1.4.1.12009.10.1.141
M1020_PRIMARY_DIAG_SEVERITY 4 Symptoms poorly controlled; history of re-hospitalizations   46512-0 LA6115-5 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG1_ICD b Other Diagnosis 1: ICD Code   46513-8   2.16.840.1.113883.6.103
M1022_OTH_DIAG1_SEVERITY   Other Diagnosis 1: Severity Rating   46514-6    
M1022_OTH_DIAG1_SEVERITY 0 Asymptomatic, no treatment needed   46514-6 LA6111-4 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG1_SEVERITY 1 Symptoms well controlled with current therapy   46514-6 LA6112-2 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG1_SEVERITY 2 Symptoms controlled with difficulty   46514-6 LA6113-0 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG1_SEVERITY 3 Symptoms poorly controlled; patient needs frequent adjustment in treatment & dose monitoring   46514-6 LA6114-8 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG1_SEVERITY 4 Symptoms poorly controlled; history of re-hospitalizations   46514-6 LA6115-5 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG2_ICD c Other Diagnosis 2: ICD Code   46515-3   2.16.840.1.113883.6.103
M1022_OTH_DIAG2_SEVERITY   Other Diagnosis 2: Severity Rating   46516-1    
M1022_OTH_DIAG2_SEVERITY 0 Asymptomatic, no treatment needed   46516-1 LA6111-4 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG2_SEVERITY 1 Symptoms well controlled with current therapy   46516-1 LA6112-2 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG2_SEVERITY 2 Symptoms controlled with difficulty   46516-1 LA6113-0 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG2_SEVERITY 3 Symptoms poorly controlled; patient needs frequent adjustment in treatment & dose monitoring   46516-1 LA6114-8 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG2_SEVERITY 4 Symptoms poorly controlled; history of re-hospitalizations   46516-1 LA6115-5 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG3_ICD d Other Diagnosis 3: ICD Code   46517-9   2.16.840.1.113883.6.103
M1022_OTH_DIAG3_SEVERITY   Other Diagnosis 3: Severity Rating   46518-7    
M1022_OTH_DIAG3_SEVERITY 0 Asymptomatic, no treatment needed   46518-7 LA6111-4 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG3_SEVERITY 1 Symptoms well controlled with current therapy   46518-7 LA6112-2 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG3_SEVERITY 2 Symptoms controlled with difficulty   46518-7 LA6113-0 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG3_SEVERITY 3 Symptoms poorly controlled; patient needs frequent adjustment in treatment & dose monitoring   46518-7 LA6114-8 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG3_SEVERITY 4 Symptoms poorly controlled; history of re-hospitalizations   46518-7 LA6115-5 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG4_ICD e Other Diagnosis 4: ICD Code   46519-5   2.16.840.1.113883.6.103
M1022_OTH_DIAG4_SEVERITY   Other Diagnosis 4: Severity Rating   46520-3    
M1022_OTH_DIAG4_SEVERITY 0 Asymptomatic, no treatment needed   46520-3 LA6111-4 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG4_SEVERITY 1 Symptoms well controlled with current therapy   46520-3 LA6112-2 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG4_SEVERITY 2 Symptoms controlled with difficulty   46520-3 LA6113-0 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG4_SEVERITY 3 Symptoms poorly controlled; patient needs frequent adjustment in treatment & dose monitoring   46520-3 LA6114-8 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG4_SEVERITY 4 Symptoms poorly controlled; history of re-hospitalizations   46520-3 LA6115-5 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG5_ICD f Other Diagnosis 5: ICD Code   46521-1   2.16.840.1.113883.6.103
M1022_OTH_DIAG5_SEVERITY   Other Diagnosis 5: Severity Rating   46522-9    
M1022_OTH_DIAG5_SEVERITY 0 Asymptomatic, no treatment needed   46522-9 LA6111-4 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG5_SEVERITY 1 Symptoms well controlled with current therapy   46522-9 LA6112-2 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG5_SEVERITY 2 Symptoms controlled with difficulty   46522-9 LA6113-0 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG5_SEVERITY 3 Symptoms poorly controlled; patient needs frequent adjustment in treatment & dose monitoring   46522-9 LA6114-8 1.3.6.1.4.1.12009.10.1.141
M1022_OTH_DIAG5_SEVERITY 4 Symptoms poorly controlled; history of re-hospitalizations   46522-9 LA6115-5 1.3.6.1.4.1.12009.10.1.141
M1024_PMT_DIAG_ICD_A3 a Case Mix Diagnosis: Primary, Column 3   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_B3 b Case Mix Diagnosis: First Secondary, Column 3   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_C3 c Case Mix Diagnosis: Second Secondary, Column 3   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_D3 d Case Mix Diagnosis: Third Secondary, Column 3   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_E3 e Case Mix Diagnosis: Fourth Secondary, Column 3   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_F3 f Case Mix Diagnosis: Fifth Secondary, Column 3   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_A4 a Case Mix Diagnosis: Primary, Column 4   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_B4 b Case Mix Diagnosis: First Secondary, Column 4   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_C4 c Case Mix Diagnosis: Second Secondary, Column 4   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_D4 d Case Mix Diagnosis: Third Secondary, Column 4   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_E4 e Case Mix Diagnosis: Fourth Secondary, Column 4   49561-4   2.16.840.1.113883.6.103
M1024_PMT_DIAG_ICD_F4 f Case Mix Diagnosis: Fifth Secondary, Column 4   49561-4   2.16.840.1.113883.6.103
M1030   Therapies the patient receives at home Question row added to facilitate message format. 46466-9    
M1030_THH_IV_INFUSION 1 Therapies Received at Home: Intravenous, Infusion   46466-9 LA6244-3 1.3.6.1.4.1.12009.10.1.142
M1030_THH_PAR_NUTRITION 2 Therapies Received at Home: Parenteral Nutrition   46466-9 LA6321-9 1.3.6.1.4.1.12009.10.1.142
M1030_THH_ENT_NUTRITION 3 Therapies Received at Home: Enteral Nutrition   46466-9 LA6194-0 1.3.6.1.4.1.12009.10.1.142
M1030_THH_NONE_ABOVE 4 Therapies Received at Home: None of the Above   46466-9 LA9-3 1.3.6.1.4.1.12009.10.1.142
M1032   Risk for hospitalization Question row added to facilitate message format. 57319-6    
M1032_HOSP_RISK_RCNT_DCLN 1 Risk For Hospitalization: Recent Decline In Mental, Emotional Or Behavior Status   57319-6 LA12130-3 1.3.6.1.4.1.12009.10.1.83
M1032_HOSP_RISK_MLTPL_HOSPZTN 2 Risk For Hospitalization: Multiple Hospitalizations (2 Or More) In Past 12 Mo   57319-6 LA12131-1 1.3.6.1.4.1.12009.10.1.83
M1032_HOSP_RISK_HSTRY_FALLS 3 Risk For Hospitalization: History Of Falls (2 Or More Falls Or Any Fall With An Injury) In Past Year   57319-6 LA12132-9 1.3.6.1.4.1.12009.10.1.83
M1032_HOSP_RISK_5PLUS_MDCTN 4 Risk For Hospitalization: Taking Five Or More Medications   57319-6 LA12133-7 1.3.6.1.4.1.12009.10.1.83
M1032_HOSP_RISK_FRAILTY 5 Risk For Hospitalization: Frailty Indicators   57319-6 LA12134-5 1.3.6.1.4.1.12009.10.1.83
M1032_HOSP_RISK_OTHR 6 Risk For Hospitalization: Other   57319-6 LA46-8 1.3.6.1.4.1.12009.10.1.83
M1032_HOSP_RISK_NONE_ABOVE 7 Risk For Hospitalization: None Of The Above   57319-6 LA9-3 1.3.6.1.4.1.12009.10.1.83
M1034_PTNT_OVRAL_STUS   Patient's Overall Status   57206-5    
M1034_PTNT_OVRAL_STUS 0 The patient is stable with no heightened risk(s) for serious complications and death (beyond those typical of the patient’s age).   57206-5 LA12137-8 1.3.6.1.4.1.12009.10.1.84
M1034_PTNT_OVRAL_STUS 1 The patient is temporarily facing high health risk(s) but is likely to return to being stable without heightened risk(s) for serious complications and death (beyond those typical of the patient’s age).   57206-5 LA12138-6 1.3.6.1.4.1.12009.10.1.84
M1034_PTNT_OVRAL_STUS 2 The patient is likely to remain in fragile health and have ongoing high risk(s) of serious complications and death.   57206-5 LA12139-4 1.3.6.1.4.1.12009.10.1.84
M1034_PTNT_OVRAL_STUS 3 The patient has serious progressive conditions that could lead to death within a year.   57206-5 LA10096-8 1.3.6.1.4.1.12009.10.1.84
M1034_PTNT_OVRAL_STUS UK The patient’s situation is unknown or unclear.   57206-5 LA12141-0 1.3.6.1.4.1.12009.10.1.84
M1036   Risk factors, either present or past, likely to affect current health status and/or outcome Question row added to facilitate message format. 57207-3    
M1036_RSK_SMOKING 1 High Risk Factor: Smoking   57207-3 LA8928-9 1.3.6.1.4.1.12009.10.1.85
M1036_RSK_OBESITY 2 High Risk Factor: Obesity   57207-3 LA6301-1 1.3.6.1.4.1.12009.10.1.85
M1036_RSK_ALCOHOLISM 3 High Risk Factor: Alcoholism   57207-3 LA6152-8 1.3.6.1.4.1.12009.10.1.85
M1036_RSK_DRUGS 4 High Risk Factor: Drugs   57207-3 LA6189-0 1.3.6.1.4.1.12009.10.1.85
M1036_RSK_NONE 5 High Risk Factor: None of the Above   57207-3 LA9-3 1.3.6.1.4.1.12009.10.1.85
M1036_RSK_UNKNOWN UK High Risk Factor: Unknown   57207-3 LA4489-6 1.3.6.1.4.1.12009.10.1.85
M1040_INFLNZ_RCVD_AGNCY   Influenza Vaccine: Did Patient Receive The Influenza Vaccine   57208-1    
M1040_INFLNZ_RCVD_AGNCY 0 No   57208-1 LA32-8 1.3.6.1.4.1.12009.10.1.86
M1040_INFLNZ_RCVD_AGNCY 1 Yes   57208-1 LA33-6 1.3.6.1.4.1.12009.10.1.86
M1040_INFLNZ_RCVD_AGNCY NA Does not apply because entire episode of care (SOC/ROC to Transfer/Discharge) is outside this influenza season.   57208-1 LA12150-1 1.3.6.1.4.1.12009.10.1.86
M1045_INFLNZ_RSN_NOT_RCVD   Influenza Vaccine: Reason Not Received In Agency   57209-9    
M1045_INFLNZ_RSN_NOT_RCVD 1 Received from another health care provider (e.g., physician)   57209-9 LA12151-9 1.3.6.1.4.1.12009.10.1.87
M1045_INFLNZ_RSN_NOT_RCVD 2 Received from your agency previously during this year's flu season   57209-9 LA12152-7 1.3.6.1.4.1.12009.10.1.87
M1045_INFLNZ_RSN_NOT_RCVD 3 Offered and declined   57209-9 LA186-9 1.3.6.1.4.1.12009.10.1.87
M1045_INFLNZ_RSN_NOT_RCVD 4 Assessed and determined to have medical contraindication(s)   57209-9 LA12154-3 1.3.6.1.4.1.12009.10.1.87
M1045_INFLNZ_RSN_NOT_RCVD 5 Not indicated; patient does not meet age/condition guidelines for influenza vaccine   57209-9 LA12155-0 1.3.6.1.4.1.12009.10.1.87
M1045_INFLNZ_RSN_NOT_RCVD 6 Inability to obtain vaccine due to declared shortage   57209-9 LA12156-8 1.3.6.1.4.1.12009.10.1.87
M1045_INFLNZ_RSN_NOT_RCVD 7 None of the above   57209-9 LA9-3 1.3.6.1.4.1.12009.10.1.87
M1050_PPV_RCVD_AGNCY   Pneumococcal Vaccine: Did Patient Receive The Influenza Vaccine   57210-7    
M1050_PPV_RCVD_AGNCY 0 No   57210-7 LA32-8 1.3.6.1.4.1.12009.10.1.62
M1050_PPV_RCVD_AGNCY 1 Yes   57210-7 LA33-6 1.3.6.1.4.1.12009.10.1.62
M1055_PPV_RSN_NOT_RCVD_AGNCY   Pneumococcal Vaccine: Reason Not Received In Agency   57211-5    
M1055_PPV_RSN_NOT_RCVD_AGNCY 1 Patient has received PPV in the past   57211-5 LA12158-4 1.3.6.1.4.1.12009.10.1.88
M1055_PPV_RSN_NOT_RCVD_AGNCY 2 Offered and declined   57211-5 LA186-9 1.3.6.1.4.1.12009.10.1.88
M1055_PPV_RSN_NOT_RCVD_AGNCY 3 Assessed and determined to have medical contraindication(s)   57211-5 LA12154-3 1.3.6.1.4.1.12009.10.1.88
M1055_PPV_RSN_NOT_RCVD_AGNCY 4 Not indicated; patient does not meet age/condition guidelines for PPV   57211-5 LA12161-8 1.3.6.1.4.1.12009.10.1.88
M1055_PPV_RSN_NOT_RCVD_AGNCY 5 None of the above   57211-5 LA9-3 1.3.6.1.4.1.12009.10.1.88
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
LIVING ARRANGEMENTS          
M1100_PTNT_LVG_STUTN   Patient Living Situation   57212-3    
M1100_PTNT_LVG_STUTN 1 Patient Lives Alone - Around the clock   57212-3 LA12163-4 1.3.6.1.4.1.12009.10.1.89
M1100_PTNT_LVG_STUTN 2 Patient Lives Alone - Regular daytime   57212-3 LA12164-2 1.3.6.1.4.1.12009.10.1.89
M1100_PTNT_LVG_STUTN 3 Patient Lives Alone - Regular nighttime   57212-3 LA12165-9 1.3.6.1.4.1.12009.10.1.89
M1100_PTNT_LVG_STUTN 4 Patient Lives Alone - Occasional / short-term assistance   57212-3 LA12166-7 1.3.6.1.4.1.12009.10.1.89
M1100_PTNT_LVG_STUTN 5 Patient Lives Alone - No assistance available   57212-3 LA12167-5 1.3.6.1.4.1.12009.10.1.89
M1100   Patient lives with other person Question row added to facilitate message format. 57213-1    
M1100_PTNT_LVG_STUTN 6 Patient Lives with Other Person - Around the clock   57213-1 LA12163-4 1.3.6.1.4.1.12009.10.1.67
M1100_PTNT_LVG_STUTN 7 Patient Lives with Other Person - Regular daytime   57213-1 LA12164-2 1.3.6.1.4.1.12009.10.1.67
M1100_PTNT_LVG_STUTN 8 Patient Lives with Other Person - Regular nighttime   57213-1 LA12165-9 1.3.6.1.4.1.12009.10.1.67
M1100_PTNT_LVG_STUTN 9 Patient Lives with Other Person - Occasional / short-term assistance   57213-1 LA12166-7 1.3.6.1.4.1.12009.10.1.67
M1100_PTNT_LVG_STUTN 10 Patient Lives with Other Person - No assistance available   57213-1 LA12167-5 1.3.6.1.4.1.12009.10.1.67
M1100   Patient lives in congregated situtation Question row added to facilitate message format. 57214-9    
M1100_PTNT_LVG_STUTN 11 Patient Lives in Congregrate Situation - Around the clock   57214-9 LA12163-4 1.3.6.1.4.1.12009.10.1.68
M1100_PTNT_LVG_STUTN 12 Patient Lives in Congregrate Situation - Regular daytime   57214-9 LA12164-2 1.3.6.1.4.1.12009.10.1.68
M1100_PTNT_LVG_STUTN 13 Patient Lives in Congregrate Situation - Regular nighttime   57214-9 LA12165-9 1.3.6.1.4.1.12009.10.1.68
M1100_PTNT_LVG_STUTN 14 Patient Lives in Congregrate Situation - Occasional / short-term assistance   57214-9 LA12166-7 1.3.6.1.4.1.12009.10.1.68
M1100_PTNT_LVG_STUTN 15 Patient Lives in Congregrate Situation - No assistance available   57214-9 LA12167-5 1.3.6.1.4.1.12009.10.1.68
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
SENSORY STATUS          
M1200_VISION   Sensory Status: Vision   57215-6    
M1200_VISION 0 Normal vision: sees adequately in most situations; can see medication labels, newsprint.   57215-6 LA12168-3 1.3.6.1.4.1.12009.10.1.90
M1200_VISION 1 Partially impaired: cannot see medication labels or newsprint, but can see obstacles in path, and the surrounding layout; can count fingers at arm's length.   57215-6 LA12169-1 1.3.6.1.4.1.12009.10.1.90
M1200_VISION 2 Severely impaired: cannot locate objects without hearing or touching them or patient nonresponsive.   57215-6 LA6375-5 1.3.6.1.4.1.12009.10.1.90
M1210_HEARG_ABLTY   Ability To Hear   57216-4    
M1210_HEARG_ABLTY 0 Adequate: hears normal conversation without difficulty.   57216-4 LA12123-8 1.3.6.1.4.1.12009.10.1.91
M1210_HEARG_ABLTY 1 Mildly to Moderately Impaired: difficulty hearing in some environments or speaker may need to increase volume or speak distinctly.   57216-4 LA12124-6 1.3.6.1.4.1.12009.10.1.91
M1210_HEARG_ABLTY 2 Severely Impaired: absence of useful hearing.   57216-4 LA12125-3 1.3.6.1.4.1.12009.10.1.91
M1210_HEARG_ABLTY UK Unable to assess hearing.   57216-4 LA12174-1 1.3.6.1.4.1.12009.10.1.91
M1220_UNDRSTG_VERBAL_CNTNT   Understanding Of Verbal Content In Patient's Own Language   57217-2    
M1220_UNDRSTG_VERBAL_CNTNT 0 Understands: clear comprehension without cues or repetitions   57217-2 LA12175-8 1.3.6.1.4.1.12009.10.1.92
M1220_UNDRSTG_VERBAL_CNTNT 1 Usually Understands: understands most conversations, but misses some part/intent of message.  Requires cues at times to understand.   57217-2 LA12176-6 1.3.6.1.4.1.12009.10.1.92
M1220_UNDRSTG_VERBAL_CNTNT 2 Sometimes Understands: understands only basic conversations or simple, direct phrases.  Frequently requires cues to understand.   57217-2 LA12177-4 1.3.6.1.4.1.12009.10.1.92
M1220_UNDRSTG_VERBAL_CNTNT 3 Rarely/Never Understands   57217-2 LA81-5 1.3.6.1.4.1.12009.10.1.92
M1220_UNDRSTG_VERBAL_CNTNT UK Unable to assess understanding   57217-2 LA12179-0 1.3.6.1.4.1.12009.10.1.92
M1230_SPEECH   Sensory Status: Speech   57218-0    
M1230_SPEECH 0 Expresses complex ideas, feelings, and needs clearly, completely, and easily in all situations with no observable impairment.   0 LA6197-3 1.3.6.1.4.1.12009.10.1.93
M1230_SPEECH 1 Minimal difficulty in expressing ideas and needs (may take extra time; makes occasional errors in word choice, grammar or speech intelligibility; needs minimal prompting or assistance).   1 LA12181-6 1.3.6.1.4.1.12009.10.1.93
M1230_SPEECH 2 Expresses simple ideas or needs with moderate difficulty (needs prompting or assistance, errors in word choice, organization or speech intelligibility). Speaks in phrases or short sentences.   2 LA12182-4 1.3.6.1.4.1.12009.10.1.93
M1230_SPEECH 3 Has severe difficulty expressing basic ideas or needs and requires maximal assistance or guessing by listener. Speech limited to single words or short phrases.   3 LA12183-2 1.3.6.1.4.1.12009.10.1.93
M1230_SPEECH 4 Unable to express basic needs even with maximal prompting or assistance but is not comatose or unresponsive (e.g., speech is nonsensical or unintelligible).   4 LA12184-0 1.3.6.1.4.1.12009.10.1.93
M1230_SPEECH 5 Patient nonresponsive or unable to speak.   5 LA6336-7 1.3.6.1.4.1.12009.10.1.93
M1240_FRML_PAIN_ASMT   Has Patient Had A Formal Pain Assessment   57219-8    
M1240_FRML_PAIN_ASMT 0 No standardized assessment conducted   57219-8 LA12186-5 1.3.6.1.4.1.12009.10.1.94
M1240_FRML_PAIN_ASMT 1 Yes, and it does not indicate severe pain   57219-8 LA12187-3 1.3.6.1.4.1.12009.10.1.94
M1240_FRML_PAIN_ASMT 2 Yes, and it indicates severe pain   57219-8 LA12188-1 1.3.6.1.4.1.12009.10.1.94
M1242_PAIN_FREQ_ACTVTY_MVMT   Frequency Of Pain Interfering With Patient's Activity Or Movement   57220-6    
M1242_PAIN_FREQ_ACTVTY_MVMT 0 Patient has no pain   57220-6 LA12189-9 1.3.6.1.4.1.12009.10.1.95
M1242_PAIN_FREQ_ACTVTY_MVMT 1 Patient has pain that does not interfere with activity or movement   57220-6 LA12190-7 1.3.6.1.4.1.12009.10.1.95
M1242_PAIN_FREQ_ACTVTY_MVMT 2 Less often than daily   57220-6 LA6249-2 1.3.6.1.4.1.12009.10.1.95
M1242_PAIN_FREQ_ACTVTY_MVMT 3 Daily, but not constantly   57220-6 LA6177-5 1.3.6.1.4.1.12009.10.1.95
M1242_PAIN_FREQ_ACTVTY_MVMT 4 All of the time   57220-6 LA6154-4 1.3.6.1.4.1.12009.10.1.95
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
INTEGUMENTARY STATUS          
M1300_PRSR_ULCR_RISK_ASMT   Was Patient Assessed For Risk Of Developing PUs   57221-4    
M1300_PRSR_ULCR_RISK_ASMT 0 No assessment conducted   57221-4 LA12194-9 1.3.6.1.4.1.12009.10.1.96
M1300_PRSR_ULCR_RISK_ASMT 1 Yes, based on an evaluation of clinical factors, e.g., mobility, incontinence, nutrition, etc., without use of standardized tool   57221-4 LA12195-6 1.3.6.1.4.1.12009.10.1.96
M1300_PRSR_ULCR_RISK_ASMT 2 Yes, using a standardized tool, e.g., Braden, Norton, other   57221-4 LA12196-4 1.3.6.1.4.1.12009.10.1.96
M1302_RISK_OF_PRSR_ULCR   Does This Patient Have A Risk Of Developing PUs   57280-0    
M1302_RISK_OF_PRSR_ULCR 0 No   57280-0 LA32-8 1.3.6.1.4.1.12009.10.1.62
M1302_RISK_OF_PRSR_ULCR 1 Yes   57280-0 LA33-6 1.3.6.1.4.1.12009.10.1.62
M1306_UNHLD_STG2_PRSR_ULCR   Patient Has At Least 1 Unhealed PU At Stage 2 Or Higher   57307-1    
M1306_UNHLD_STG2_PRSR_ULCR 0 No   57307-1 LA32-8 1.3.6.1.4.1.12009.10.1.62
M1306_UNHLD_STG2_PRSR_ULCR 1 Yes   57307-1 LA33-6 1.3.6.1.4.1.12009.10.1.62
M1307_OLDST_STG2_AT_DSCHRG   Status Of Oldest Stage II Pressure Ulcer At Discharge   57222-2    
M1307_OLDST_STG2_AT_DSCHRG 1 Was present at the most recent SOC/ROC assessment   57222-2 LA12403-4 1.3.6.1.4.1.12009.10.1.97
M1307_OLDST_STG2_AT_DSCHRG 2 Developed since the most recent SOC/ROC assessment   57222-2 LA12404-2 1.3.6.1.4.1.12009.10.1.97
M1307_OLDST_STG2_AT_DSCHRG NA No non-epithelialized Stage II pressure ulcers are present at discharge   57222-2 LA12405-9 1.3.6.1.4.1.12009.10.1.97
M1307_OLDST_STG2_ONST_DT   Date Of Onset Of Oldest Stage II Pressure Ulcer        
M1308_NBR_PRSULC_STG2 a No. Pressure Ulcers - Stage 2   55124-2    
M1308_NBR_STG2_AT_SOC_ROC   Number PU Stage 2 At SOC/ROC   54886-7    
M1308_NBR_PRSULC_STG3 b No. Pressure Ulcers - Stage 3   55125-9    
M1308_NBR_STG3_AT_SOC_ROC   Number PU Stage 3 At SOC/ROC   54887-5    
M1308_NBR_PRSULC_STG4 c No. Pressure Ulcers - Stage 4   55126-7    
M1308_NBR_STG4_AT_SOC_ROC   Number PU Stage 4 At SOC/ROC   54890-9    
M1308_NSTG_DRSG d1 Unstageable Due To Non-removable Dressing Or Device   54893-3    
M1308_NSTG_DRSG_SOC_ROC   Unstageable Due To Non-removable Dressing Or Device At SOC/ROC   54894-1    
M1308_NSTG_CVRG d2 Unstageable Due To Coverage By Slough Or Eschar   54946-9    
M1308_NSTG_CVRG_SOC_ROC   Unstageable Due To Coverage By Slough Or Eschar At SOC/ROC   54947-7    
M1308_NSTG_DEEP_TISUE d3 Unstageable Due To Suspected Deep Tissue Injury In Evolution   54950-1    
M1308_NSTG_DEEP_TISUE_SOC_ROC   Unstageable Due To Suspected Deep Tissue Injury In Evolution At SOC/ROC   54951-9    
M1310_PRSR_ULCR_LNGTH   Head To Toe Length Of Stage III Or IV Pu With Largest Area   57226-3    
M1312_PRSR_ULCR_WDTH   Width At Right Angles Of Stage III Or IV Pu With Largest Area   52729-1    
M1314_PRSR_ULCR_DEPTH   Depth Of Stage III Or IV Pu With Largest Area   57228-9    
M1320_STUS_PRBLM_PRSR_ULCR   Status Of Most Problematic Pressure Ulcer   57229-7    
M1320_STUS_PRBLM_PRSR_ULCR 0 Newly epithelialized   57229-7 LA12197-2 1.3.6.1.4.1.12009.10.1.98
M1320_STUS_PRBLM_PRSR_ULCR 1 Fully granulating   57229-7 LA6203-9 1.3.6.1.4.1.12009.10.1.98
M1320_STUS_PRBLM_PRSR_ULCR 2 Early/partial granulation   57229-7 LA6193-2 1.3.6.1.4.1.12009.10.1.98
M1320_STUS_PRBLM_PRSR_ULCR 3 Not healing   57229-7 LA6300-3 1.3.6.1.4.1.12009.10.1.98
M1320_STUS_PRBLM_PRSR_ULCR NA No observable pressure ulcer   57229-7 LA6286-4 1.3.6.1.4.1.12009.10.1.98
M1322_NBR_PRSULC_STG1   No. Pressure Ulcers - Stage 1   46536-9    
M1322_NBR_PRSULC_STG1 0 Zero   46536-9 LA6458-9 1.3.6.1.4.1.12009.10.1.143
M1322_NBR_PRSULC_STG1 1 One   46536-9 LA6306-0 1.3.6.1.4.1.12009.10.1.143
M1322_NBR_PRSULC_STG1 2 Two   46536-9 LA6404-3 1.3.6.1.4.1.12009.10.1.143
M1322_NBR_PRSULC_STG1 3 Three   46536-9 LA6395-3 1.3.6.1.4.1.12009.10.1.143
M1322_NBR_PRSULC_STG1 4 Four or more   46536-9 LA6200-5 1.3.6.1.4.1.12009.10.1.143
M1324_STG_PRBLM_ULCER   Stage of Most Problematic Pressure Ulcer   57231-3    
M1324_STG_PRBLM_ULCER 1 Stage I   57231-3 LA3664-5 1.3.6.1.4.1.12009.10.1.100
M1324_STG_PRBLM_ULCER 2 Stage II   57231-3 LA3661-1 1.3.6.1.4.1.12009.10.1.100
M1324_STG_PRBLM_ULCER 3 Stage III   57231-3 LA3657-9 1.3.6.1.4.1.12009.10.1.100
M1324_STG_PRBLM_ULCER 4 Stage IV   57231-3 LA3651-2 1.3.6.1.4.1.12009.10.1.100
M1324_STG_PRBLM_ULCER NA No observable pressure ulcer or unhealed pressure ulcer   57231-3 LA12211-1 1.3.6.1.4.1.12009.10.1.100
M1330_STAS_ULCR_PRSNT   Does This Patient Have A Stasis Ulcer   57232-1    
M1330_STAS_ULCR_PRSNT 0 No   57232-1 LA32-8 1.3.6.1.4.1.12009.10.1.101
M1330_STAS_ULCR_PRSNT 1 Yes, patient has BOTH observable and unobservable stasis ulcers   57232-1 LA12402-6 1.3.6.1.4.1.12009.10.1.101
M1330_STAS_ULCR_PRSNT 2 Yes, patient has observable stasis ulcers ONLY   57232-1 LA12400-0 1.3.6.1.4.1.12009.10.1.101
M1330_STAS_ULCR_PRSNT 3 Yes, patient has unobservable stasis ulcers ONLY (known but not observable due to non-removable dressing)   57232-1 LA12401-8 1.3.6.1.4.1.12009.10.1.101
M1332_NUM_STAS_ULCR   No. Stasis Ulcers   57233-9    
M1332_NUM_STAS_ULCR 1 One   57233-9 LA6306-0 1.3.6.1.4.1.12009.10.1.102
M1332_NUM_STAS_ULCR 2 Two   57233-9 LA6404-3 1.3.6.1.4.1.12009.10.1.102
M1332_NUM_STAS_ULCR 3 Three   57233-9 LA6395-3 1.3.6.1.4.1.12009.10.1.102
M1332_NUM_STAS_ULCR 4 Four or more   57233-9 LA6200-5 1.3.6.1.4.1.12009.10.1.102
M1334_STUS_PRBLM_STAS_ULCR   Status Of Most Problematic Stasis Ulcer   57234-7    
M1334_STUS_PRBLM_STAS_ULCR 0 Newly epithelialized   57234-7 LA12197-2 1.3.6.1.4.1.12009.10.1.103
M1334_STUS_PRBLM_STAS_ULCR 1 Fully granulating   57234-7 LA6203-9 1.3.6.1.4.1.12009.10.1.103
M1334_STUS_PRBLM_STAS_ULCR 2 Early/partial granulation   57234-7 LA6193-2 1.3.6.1.4.1.12009.10.1.103
M1334_STUS_PRBLM_STAS_ULCR 3 Not healing   57234-7 LA6300-3 1.3.6.1.4.1.12009.10.1.103
M1340_SRGCL_WND_PRSNT   Does This Patient Have A Surgical Wound   57235-4    
M1340_SRGCL_WND_PRSNT 0 No [ Go to M1350 ]   57235-4 LA12632-8 1.3.6.1.4.1.12009.10.1.69
M1340_SRGCL_WND_PRSNT 1 Yes, patient has at least one (observable) surgical wound   57235-4 LA12633-6 1.3.6.1.4.1.12009.10.1.69
M1340_SRGCL_WND_PRSNT 2 Surgical wound known but not observable due to non-removable dressing [ Go to M1350 ]   57235-4 LA12634-4 1.3.6.1.4.1.12009.10.1.69
M1342_STUS_PRBLM_SRGCL_WND   Status Of Most Problematic Surgical Wound   57236-2    
M1342_STUS_PRBLM_SRGCL_WND 0 Newly epithelialized   57236-2 LA12197-2 1.3.6.1.4.1.12009.10.1.103
M1342_STUS_PRBLM_SRGCL_WND 1 Fully granulating   57236-2 LA6203-9 1.3.6.1.4.1.12009.10.1.103
M1342_STUS_PRBLM_SRGCL_WND 2 Early/partial granulation   57236-2 LA6193-2 1.3.6.1.4.1.12009.10.1.103
M1342_STUS_PRBLM_SRGCL_WND 3 Not healing   57236-2 LA6300-3 1.3.6.1.4.1.12009.10.1.103
M1350_LESION_OPEN_WND   Has Skin Lesion Or Open Wound   46534-4    
M1350_LESION_OPEN_WND 0 No   46534-4 LA32-8 1.3.6.1.4.1.12009.10.1.62
M1350_LESION_OPEN_WND 1 Yes   46534-4 LA33-6 1.3.6.1.4.1.12009.10.1.62
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
RESPIRATORY STATUS          
M1400_WHEN_DYSPNEIC   When Dyspneic   57237-0    
M1400_WHEN_DYSPNEIC 0 Patient is not short of breath   57237-0 LA12224-4 1.3.6.1.4.1.12009.10.1.104
M1400_WHEN_DYSPNEIC 1 When walking more than 20 feet, climbing stairs   57237-0 LA6443-1 1.3.6.1.4.1.12009.10.1.104
M1400_WHEN_DYSPNEIC 2 With moderate exertion (e.g., while dressing, using commode or bedpan, walking distances less than 20 feet)   57237-0 LA6446-4 1.3.6.1.4.1.12009.10.1.104
M1400_WHEN_DYSPNEIC 3 With minimal exertion (e.g., while eating, talking, or performing other ADLs) or with agitation   57237-0 LA6445-6 1.3.6.1.4.1.12009.10.1.104
M1400_WHEN_DYSPNEIC 4 At rest (during day or night)   57237-0 LA6158-5 1.3.6.1.4.1.12009.10.1.104
M1410   Respiratory treatments utilized at home: Question row added to facilitate message format. 57238-8    
M1410_RESPTX_OXYGEN 1 Respiratory Treatments: Oxygen   57238-8 LA6319-3 1.3.6.1.4.1.12009.10.1.105
M1410_RESPTX_VENTILATOR 2 Respiratory Treatments: Ventilator   57238-8 LA6438-1 1.3.6.1.4.1.12009.10.1.105
M1410_RESPTX_AIRPRESS 3 Respiratory Treatments: Airway Pressure   57238-8 LA12231-9 1.3.6.1.4.1.12009.10.1.105
M1410_RESPTX_NONE 4 Respiratory Treatments: None of the Above   57238-8 LA9-3 1.3.6.1.4.1.12009.10.1.105
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
CARDIAC STATUS          
M1500_SYMTM_HRT_FAILR_PTNTS   Symptoms In Heart Failure Patients   57239-6    
M1500_SYMTM_HRT_FAILR_PTNTS 0 No   57239-6 LA32-8 1.3.6.1.4.1.12009.10.1.106
M1500_SYMTM_HRT_FAILR_PTNTS 1 Yes   57239-6 LA33-6 1.3.6.1.4.1.12009.10.1.106
M1500_SYMTM_HRT_FAILR_PTNTS 2 Not assessed   57239-6 LA9348-9 1.3.6.1.4.1.12009.10.1.106
M1500_SYMTM_HRT_FAILR_PTNTS NA Patient does not have diagnosis of heart failure   57239-6 LA12236-8 1.3.6.1.4.1.12009.10.1.106
M1510   Heart failure follow-up Question row added to facilitate message format. 57240-4    
M1510_HRT_FAILR_NO_ACTN 0 Heart Failure Follow Up:  No Action   57240-4 LA12237-6 1.3.6.1.4.1.12009.10.1.107
M1510_HRT_FAILR_PHYSN_CNTCT 1 Heart Failure Follow Up:  Physician Contacted   57240-4 LA12238-4 1.3.6.1.4.1.12009.10.1.107
M1510_HRT_FAILR_ER_TRTMT 2 Heart Failure Follow Up:  ER Treatment Advised   57240-4 LA12239-2 1.3.6.1.4.1.12009.10.1.107
M1510_HRT_FAILR_PHYSN_TRTMT 3 Heart Failure Follow Up:  Physician-Ordered Treatment Implemented   57240-4 LA12240-0 1.3.6.1.4.1.12009.10.1.107
M1510_HRT_FAILR_CLNCL_INTRVTN 4 Heart Failure Follow Up:  Patient Education Or Other Clinical Interventions   57240-4 LA12241-8 1.3.6.1.4.1.12009.10.1.107
M1510_HRT_FAILR_CARE_PLAN_CHG 5 Heart Failure Follow Up: Change In Care Plan Orders Obtained   57240-4 LA12242-6 1.3.6.1.4.1.12009.10.1.107
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
ELIMINATION STATUS          
M1600_UTI   Treated for Urinary Tract Infection in Past 14 Days   46552-6    
M1600_UTI 0 No   46552-6 LA32-8 1.3.6.1.4.1.12009.10.1.144
M1600_UTI 1 Yes   46552-6 LA33-6 1.3.6.1.4.1.12009.10.1.144
M1600_UTI NA Patient on prophylactic treatment   46552-6 LA6337-5 1.3.6.1.4.1.12009.10.1.144
M1600_UTI UK Unknown   46552-6 LA4489-6 1.3.6.1.4.1.12009.10.1.144
M1610_UR_INCONT   Urinary Incontinence or Urinary Catheter Present   46553-4    
M1610_UR_INCONT 0 No incontinence or catheter (includes anuria or ostomy for urinary drainage)   46553-4 LA6278-1 1.3.6.1.4.1.12009.10.1.145
M1610_UR_INCONT 1 Patient is incontinent   46553-4 LA6332-6 1.3.6.1.4.1.12009.10.1.145
M1610_UR_INCONT 2 Patient requires a urinary catheter (i.e., external, indwelling, intermittent, suprapubic)   46553-4 LA6339-1 1.3.6.1.4.1.12009.10.1.145
M1615_INCNTNT_TIMING   When Urinary Incontinence Occurs   57241-2    
M1615_INCNTNT_TIMING 0 Timed-voiding defers incontinence   57241-2 LA6397-9 1.3.6.1.4.1.12009.10.1.108
M1615_INCNTNT_TIMING 1 Occasional stress incontinence   57241-2 LA12244-2 1.3.6.1.4.1.12009.10.1.108
M1615_INCNTNT_TIMING 2 During the night only   57241-2 LA6192-4 1.3.6.1.4.1.12009.10.1.108
M1615_INCNTNT_TIMING 3 During the day only   57241-2 LA12246-7 1.3.6.1.4.1.12009.10.1.108
M1615_INCNTNT_TIMING 4 During the day and night   57241-2 LA6191-6 1.3.6.1.4.1.12009.10.1.108
M1620_BWL_INCONT   Bowel Incontinence Frequency   46587-2    
M1620_BWL_INCONT 0 Very rarely or never has bowel incontinence   46587-2 LA6440-7 1.3.6.1.4.1.12009.10.1.146
M1620_BWL_INCONT 1 Less than once weekly   46587-2 LA6252-6 1.3.6.1.4.1.12009.10.1.146
M1620_BWL_INCONT 2 One to three times weekly   46587-2 LA6307-8 1.3.6.1.4.1.12009.10.1.146
M1620_BWL_INCONT 3 Four to six times weekly   46587-2 LA6201-3 1.3.6.1.4.1.12009.10.1.146
M1620_BWL_INCONT 4 On a daily basis   46587-2 LA6302-9 1.3.6.1.4.1.12009.10.1.146
M1620_BWL_INCONT 5 More often than once daily   46587-2 LA6263-3 1.3.6.1.4.1.12009.10.1.146
M1620_BWL_INCONT NA Patient has ostomy for bowel elimination   46587-2 LA6330-0 1.3.6.1.4.1.12009.10.1.146
M1620_BWL_INCONT UK Unknown   46587-2 LA4489-6 1.3.6.1.4.1.12009.10.1.146
M1630_OSTOMY   Ostomy for Bowel Elimination   46588-0    
M1630_OSTOMY 0 Patient does NOT have an ostomy for bowel elimination.   46588-0 LA6328-4 1.3.6.1.4.1.12009.10.1.147
M1630_OSTOMY 1 Patient's ostomy was NOT related to an inpatient stay and did NOT necessitate change in medical or treatment regimen.   46588-0 LA6343-3 1.3.6.1.4.1.12009.10.1.147
M1630_OSTOMY 2 The ostomy WAS related to an inpatient stay or DID necessitate change in medical or treatment regimen.   46588-0 LA6392-0 1.3.6.1.4.1.12009.10.1.147
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
NEURO/EMOTIONAL/ BEHAVIORAL STATUS          
M1700_COG_FUNCTION   Cognitive Functioning   46589-8    
M1700_COG_FUNCTION 0 Alert/oriented, able to focus and shift attention, comprehends and recalls task directions independently.   46589-8 LA6153-6 1.3.6.1.4.1.12009.10.1.148
M1700_COG_FUNCTION 1 Requires prompting (cueing, repetition, reminders) only under stressful or unfamiliar conditions.   46589-8 LA6362-3 1.3.6.1.4.1.12009.10.1.148
M1700_COG_FUNCTION 2 Requires assistance/direction in specific situations (e.g., all tasks involving shifting of attention) or consistently requires low stimulus environmnt due to distractibility.   46589-8 LA6359-9 1.3.6.1.4.1.12009.10.1.148
M1700_COG_FUNCTION 3 Requires considerable assist in routine situations. Is not alert and oriented or is unable to shift attention and recall directions more than half the time.   46589-8 LA6360-7 1.3.6.1.4.1.12009.10.1.148
M1700_COG_FUNCTION 4 Totally dependent due to disturbances such as constant disorientation, coma, persistent vegetative state, or delirium.   46589-8 LA6399-5 1.3.6.1.4.1.12009.10.1.148
M1710_WHEN_CONFUSED   When Confused (Reported or Observed)   58104-1    
M1710_WHEN_CONFUSED 0 Never   58104-1 LA6270-8 1.3.6.1.4.1.12009.10.1.137
M1710_WHEN_CONFUSED 1 In new or complex situations only   58104-1 LA6231-0 1.3.6.1.4.1.12009.10.1.137
M1710_WHEN_CONFUSED 2 On awakening or at night only   58104-1 LA6303-7 1.3.6.1.4.1.12009.10.1.137
M1710_WHEN_CONFUSED 3 During the day and evening, but not constantly   58104-1 LA6190-8 1.3.6.1.4.1.12009.10.1.137
M1710_WHEN_CONFUSED 4 Constantly   58104-1 LA6174-2 1.3.6.1.4.1.12009.10.1.137
M1710_WHEN_CONFUSED NA Patient nonresponsive   58104-1 LA6335-9 1.3.6.1.4.1.12009.10.1.137
M1720_WHEN_ANXIOUS   When Anxious (Reported or Observed)   46591-4    
M1720_WHEN_ANXIOUS 0 None of the time   46591-4 LA6297-1 1.3.6.1.4.1.12009.10.1.149
M1720_WHEN_ANXIOUS 1 Less often than daily   46591-4 LA6249-2 1.3.6.1.4.1.12009.10.1.149
M1720_WHEN_ANXIOUS 2 Daily, but not constantly   46591-4 LA6177-5 1.3.6.1.4.1.12009.10.1.149
M1720_WHEN_ANXIOUS 3 All of the time   46591-4 LA6154-4 1.3.6.1.4.1.12009.10.1.149
M1720_WHEN_ANXIOUS NA Patient nonresponsive   46591-4 LA6335-9 1.3.6.1.4.1.12009.10.1.149
M1730_STDZ_DPRSN_SCRNG   Has The Patient Been Screened For Depression Using Stdzed Screen Tool   57242-0    
M1730_STDZ_DPRSN_SCRNG 0 No   57242-0 LA32-8 1.3.6.1.4.1.12009.10.1.110
M1730_STDZ_DPRSN_SCRNG 1 Yes, patient was screened using the PHQ-2©* scale. (Instructions for this two-question tool: Ask patient: “Over the last two weeks, how often have you been bothered by any of the following problems”)   57242-0 LA12254-1 1.3.6.1.4.1.12009.10.1.110
M1730_PHQ2_LACK_INTRST 1a PHQ2 Pfizer Little Interest Or Pleasure In Doing Things   44250-9    
M1730_PHQ2_LACK_INTRST 1a-0 Not at all (0 - 1 days)   44250-9 LA6568-5 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_LACK_INTRST 1a-1 Several days (2-6 days)   44250-9 LA6569-3 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_LACK_INTRST 1a-2 More than half of the days (7-11 days)   44250-9 LA6570-1 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_LACK_INTRST 1a-3 Nearly every day (12-14 days)   44250-9 LA6571-9 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_LACK_INTRST 1a-NA Unable to respond        
M1730_PHQ2_DPRSN 1b PHQ2 Pfizer Feeling Down, Depressed Or Hopeless   44255-8    
M1730_PHQ2_DPRSN 1b-0 Not at all (0 - 1 days)   44255-8 LA6568-5 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_DPRSN 1b-1 Several days (2-6 days)   44255-8 LA6569-3 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_DPRSN 1b-2 More than half of the days (7-11 days)   44255-8 LA6570-1 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_DPRSN 1b-3 Nearly every day (12-14 days)   44255-8 LA6571-9 1.3.6.1.4.1.12009.10.1.158
M1730_PHQ2_DPRSN 1b-NA Unable to respond        
M1730_STDZ_DPRSN_SCRNG 2 Yes, with a different standardized assessment-and the patient meets criteria for further evaluation for depression.   57242-0 LA12255-8 1.3.6.1.4.1.12009.10.1.110
M1730_STDZ_DPRSN_SCRNG 3 Yes, patient was screened with a different standardized assessment-and the patient does not meet criteria for further evaluation for depression.   57242-0 LA12256-6 1.3.6.1.4.1.12009.10.1.110
M1740   Cognitive, behavorial, and psychiatric symptoms that are demonstrated at least once a week (Reported or Observed): Question row added to facilitate message format. 46473-5    
M1740_BD_MEM_DEFICIT 1 Behavior Demonstrated: Memory Deficit   46473-5 LA6260-9 1.3.6.1.4.1.12009.10.1.150
M1740_BD_IMP_DECISN 2 Behavior Demonstrated: Impaired Decision-making   46473-5 LA6228-6 1.3.6.1.4.1.12009.10.1.150
M1740_BD_VERBAL 3 Behavior Demonstrated: Verbal Disruption   46473-5 LA6439-9 1.3.6.1.4.1.12009.10.1.150
M1740_BD_PHYSICAL 4 Behavior Demonstrated: Physical Aggression   46473-5 LA6347-4 1.3.6.1.4.1.12009.10.1.150
M1740_BD_SOC_INAPPRO 5 Behavior Demonstrated: Socially Inappropriate   46473-5 LA6187-4 1.3.6.1.4.1.12009.10.1.150
M1740_BD_DELUSIONS 6 Behavior Demonstrated: Delusions   46473-5 LA6181-7 1.3.6.1.4.1.12009.10.1.150
M1740_BD_NONE 7 Behavior Demonstrated: None of the Above   46473-5 LA6294-8 1.3.6.1.4.1.12009.10.1.150
M1745_BEH_PROB_FREQ   Frequency of Behavior Problems   46592-2    
M1745_BEH_PROB_FREQ 0 Never   46592-2 LA6270-8 1.3.6.1.4.1.12009.10.1.151
M1745_BEH_PROB_FREQ 1 Less than once a month   46592-2 LA6251-8 1.3.6.1.4.1.12009.10.1.151
M1745_BEH_PROB_FREQ 2 Once a month   46592-2 LA6304-5 1.3.6.1.4.1.12009.10.1.151
M1745_BEH_PROB_FREQ 3 Several times each month   46592-2 LA6374-8 1.3.6.1.4.1.12009.10.1.151
M1745_BEH_PROB_FREQ 4 Several times a week   46592-2 LA6371-4 1.3.6.1.4.1.12009.10.1.151
M1745_BEH_PROB_FREQ 5 At least daily   46592-2 LA6157-7 1.3.6.1.4.1.12009.10.1.151
M1750_REC_PSYCH_NURS   Receives Psychiatric Nursing   46593-0    
M1750_REC_PSYCH_NURS 0 No   46593-0 LA32-8 1.3.6.1.4.1.12009.10.1.62
M1750_REC_PSYCH_NURS 1 Yes   46593-0 LA33-6 1.3.6.1.4.1.12009.10.1.62
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
ADL/IADLs          
M1800_CUR_GROOMING   Current: Grooming   46595-5    
M1800_CUR_GROOMING 0 Able to groom self unaided, with or without the use of assistive devices or adapted methods.   46595-5 LA6131-2 1.3.6.1.4.1.12009.10.1.152
M1800_CUR_GROOMING 1 Grooming utensils must be placed within reach before able to complete grooming activities.   46595-5 LA6207-0 1.3.6.1.4.1.12009.10.1.152
M1800_CUR_GROOMING 2 Someone must assist the patient to groom self.   46595-5 LA6379-7 1.3.6.1.4.1.12009.10.1.152
M1800_CUR_GROOMING 3 Patient depends entirely upon someone else for grooming needs.   46595-5 LA6326-8 1.3.6.1.4.1.12009.10.1.152
M1810_CUR_DRESS_UPPER   Current: Dress Upper Body   46597-1    
M1810_CUR_DRESS_UPPER 0 Able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance.   46597-1 LA6129-6 1.3.6.1.4.1.12009.10.1.153
M1810_CUR_DRESS_UPPER 1 Able to dress upper body without assistance if clothing is laid out or handed to the patient.   46597-1 LA6127-0 1.3.6.1.4.1.12009.10.1.153
M1810_CUR_DRESS_UPPER 2 Someone must help the patient put on upper body clothing.   46597-1 LA6381-3 1.3.6.1.4.1.12009.10.1.153
M1810_CUR_DRESS_UPPER 3 Patient depends entirely upon another person to dress the upper body.   46597-1 LA6325-0 1.3.6.1.4.1.12009.10.1.153
M1820_CUR_DRESS_LOWER   Current: Dress Lower Body   46599-7    
M1820_CUR_DRESS_LOWER 0 Able to obtain, put on, and remove clothing and shoes without assistance.   46599-7 LA6138-7 1.3.6.1.4.1.12009.10.1.154
M1820_CUR_DRESS_LOWER 1 Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient.   46599-7 LA6126-2 1.3.6.1.4.1.12009.10.1.154
M1820_CUR_DRESS_LOWER 2 Someone must help the patient put on undergarments, slacks, socks or nylons, and shoes.   46599-7 LA6380-5 1.3.6.1.4.1.12009.10.1.154
M1820_CUR_DRESS_LOWER 3 Patient depends entirely upon another person to dress lower body.   46599-7 LA6324-3 1.3.6.1.4.1.12009.10.1.154
M1830_CRNT_BATHG   Current: Bathing   57243-8    
M1830_CRNT_BATHG 0 Able to bathe self in shower or tub independently, including getting in and out of tub/shower.   57243-8 LA12264-0 1.3.6.1.4.1.12009.10.1.112
M1830_CRNT_BATHG 1 With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower.   57243-8 LA12265-7 1.3.6.1.4.1.12009.10.1.112
M1830_CRNT_BATHG 2 Able to bathe in shower or tub with the intermittent assistance of another person: (a) for intermittent supervision or encouragement or reminders, OR (b) to get in and out of the shower or tub, OR (c) for washing difficult to reach areas.   57243-8 LA12266-5 1.3.6.1.4.1.12009.10.1.112
M1830_CRNT_BATHG 3 Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision.   57243-8 LA12267-3 1.3.6.1.4.1.12009.10.1.112
M1830_CRNT_BATHG 4 Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode.   57243-8 LA12268-1 1.3.6.1.4.1.12009.10.1.112
M1830_CRNT_BATHG 5 Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath.   57243-8 LA12269-9 1.3.6.1.4.1.12009.10.1.112
M1830_CRNT_BATHG 6 Unable to participate effectively in bathing and is bathed totally by another person.   57243-8 LA12270-7 1.3.6.1.4.1.12009.10.1.112
M1840_CUR_TOILTG   Current: Toileting   57244-6    
M1840_CUR_TOILTG 0 Able to get to and from the toilet and transfer independently with or without a device.   57244-6 LA12271-5 1.3.6.1.4.1.12009.10.1.113
M1840_CUR_TOILTG 1 When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.   57244-6 LA12272-3 1.3.6.1.4.1.12009.10.1.113
M1840_CUR_TOILTG 2 Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).   57244-6 LA6415-9 1.3.6.1.4.1.12009.10.1.113
M1840_CUR_TOILTG 3 Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently.   57244-6 LA6416-7 1.3.6.1.4.1.12009.10.1.113
M1840_CUR_TOILTG 4 Is totally dependent in toileting.   57244-6 LA6245-0 1.3.6.1.4.1.12009.10.1.113
M1845_CUR_TOILTG_HYGN   Current: Toileting Hygiene   57245-3    
M1845_CUR_TOILTG_HYGN 0 Able to manage toileting hygiene and clothing management without assistance.   57245-3 LA12276-4 1.3.6.1.4.1.12009.10.1.114
M1845_CUR_TOILTG_HYGN 1 Able to manage toileting hygiene and clothing management without assistance if supplies/implements are laid out for the patient.   57245-3 LA12277-2 1.3.6.1.4.1.12009.10.1.114
M1845_CUR_TOILTG_HYGN 2 Someone must help the patient to maintain toileting hygiene and/or adjust clothing.   57245-3 LA12278-0 1.3.6.1.4.1.12009.10.1.114
M1845_CUR_TOILTG_HYGN 3 Patient depends entirely upon another person to maintain toileting hygiene.   57245-3 LA12279-8 1.3.6.1.4.1.12009.10.1.114
M1850_CUR_TRNSFRNG   Current: Transferring   57246-1    
M1850_CUR_TRNSFRNG 0 Able to independently transfer.   57246-1 LA6136-1 1.3.6.1.4.1.12009.10.1.115
M1850_CUR_TRNSFRNG 1 Able to transfer with minimal human assistance or with use of an assistive device.   57246-1 LA12281-4 1.3.6.1.4.1.12009.10.1.115
M1850_CUR_TRNSFRNG 2 Able to bear weight and pivot during the transfer process but unable to transfer self.   57246-1 LA12282-2 1.3.6.1.4.1.12009.10.1.115
M1850_CUR_TRNSFRNG 3 Unable to transfer self and is unable to bear weight or pivot when transferred by another person.   57246-1 LA6426-6 1.3.6.1.4.1.12009.10.1.115
M1850_CUR_TRNSFRNG 4 Bedfast, unable to transfer but is able to turn and position self in bed.   57246-1 LA6161-9 1.3.6.1.4.1.12009.10.1.115
M1850_CUR_TRNSFRNG 5 Bedfast, unable to transfer and is unable to turn and position self.   57246-1 LA6160-1 1.3.6.1.4.1.12009.10.1.115
M1860_CRNT_AMBLTN   Current: Ambulation   57247-9    
M1860_CRNT_AMBLTN 0 Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no human assistance or assistive device).   57247-9 LA12286-3 1.3.6.1.4.1.12009.10.1.116
M1860_CRNT_AMBLTN 1 With the use of a one-handed device (e.g. cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.   57247-9 LA12287-1 1.3.6.1.4.1.12009.10.1.116
M1860_CRNT_AMBLTN 2 Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.   57247-9 LA12288-9 1.3.6.1.4.1.12009.10.1.116
M1860_CRNT_AMBLTN 3 Able to walk only with the supervision or assistance of another person at all times.   57247-9 LA6147-8 1.3.6.1.4.1.12009.10.1.116
M1860_CRNT_AMBLTN 4 Chairfast, unable to ambulate but is able to wheel self independently.   57247-9 LA6171-8 1.3.6.1.4.1.12009.10.1.116
M1860_CRNT_AMBLTN 5 Chairfast, unable to ambulate and is unable to wheel self.   57247-9 LA6170-0 1.3.6.1.4.1.12009.10.1.116
M1860_CRNT_AMBLTN 6 Bedfast, unable to ambulate or be up in a chair.   57247-9 LA6159-3 1.3.6.1.4.1.12009.10.1.116
M1870_CUR_FEEDING   Current: Feeding   57248-7    
M1870_CUR_FEEDING 0 Able to independently feed self.   57248-7 LA6133-8 1.3.6.1.4.1.12009.10.1.117
M1870_CUR_FEEDING 1 Able to feed self independently but requires: (a) meal set-up; OR (b) intermittent assistance or supervision from another person; OR (c) a liquid, pureed or ground meat diet.   57248-7 LA12294-7 1.3.6.1.4.1.12009.10.1.117
M1870_CUR_FEEDING 2 Unable to feed self and must be assisted or supervised throughout the meal/snack.   57248-7 LA6414-2 1.3.6.1.4.1.12009.10.1.117
M1870_CUR_FEEDING 3 Able to take in nutrients orally and receives supplemental nutrients through a nasogastric tube or gastrostomy.   57248-7 LA6142-9 1.3.6.1.4.1.12009.10.1.117
M1870_CUR_FEEDING 4 Unable to take in nutrients orally and is fed nutrients through a nasogastric tube or gastrostomy.   57248-7 LA6422-5 1.3.6.1.4.1.12009.10.1.117
M1870_CUR_FEEDING 5 Unable to take in nutrients orally or by tube feeding.   57248-7 LA6423-3 1.3.6.1.4.1.12009.10.1.117
M1880_CUR_PREP_LT_MEALS   Current: Prepare Light Meals   57249-5    
M1880_CUR_PREP_LT_MEALS 0 (a) Able to independently plan and prepare all light meals for self or reheat delivered meals; OR (b) Is physically, cognitively, and mentally able to prepare light meals on a regular basis but has not routinely performed light meal preparation in the pas   57249-5 LA12299-6 1.3.6.1.4.1.12009.10.1.118
M1880_CUR_PREP_LT_MEALS 1 Unable to prepare light meals on a regular basis due to physical, cognitive, or mental limitations.   57249-5 LA6420-9 1.3.6.1.4.1.12009.10.1.118
M1880_CUR_PREP_LT_MEALS 2 Unable to prepare any light meals or reheat any delivered meals.   57249-5 LA6419-1 1.3.6.1.4.1.12009.10.1.118
M1890_CUR_PHONE_USE   Current: Telephone Use   46569-0    
M1890_CUR_PHONE_USE 0 Able to dial numbers and answer calls appropriately and as desired.   46569-0 LA6124-7 1.3.6.1.4.1.12009.10.1.155
M1890_CUR_PHONE_USE 1 Able to use a specially adapted telephone (i.e., large numbers on the dial, teletype phone for the deaf) and call essential numbers.   46569-0 LA6146-0 1.3.6.1.4.1.12009.10.1.155
M1890_CUR_PHONE_USE 2 Able to answer the telephone and carry on a normal conversation but has difficulty with placing calls.   46569-0 LA6121-3 1.3.6.1.4.1.12009.10.1.155
M1890_CUR_PHONE_USE 3 Able to answer the telephone only some of the time or is able to carry on only a limited conversation.   46569-0 LA6122-1 1.3.6.1.4.1.12009.10.1.155
M1890_CUR_PHONE_USE 4 UNABLE to answer the telephone at all but can listen if assisted with equipment.   46569-0 LA6409-2 1.3.6.1.4.1.12009.10.1.155
M1890_CUR_PHONE_USE 5 Totally unable to use the telephone.   46569-0 LA6400-1 1.3.6.1.4.1.12009.10.1.155
M1890_CUR_PHONE_USE NA Patient does not have a telephone.   46569-0 LA6327-6 1.3.6.1.4.1.12009.10.1.155
M1900_PRIOR_ADLIADL_SELF a Prior Functioning ADL/IADL: Self-care (grooming, Bathing, Dressing)   57250-3    
M1900_PRIOR_ADLIADL_SELF a-0 Independent   57250-3 LA12302-8 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_SELF a-1 Needed Some Help   57250-3 LA12303-6 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_SELF a-2 Dependent   57250-3 LA12304-4 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_AMBLTN b Prior Functioning ADL/IADL: Ambulation   57251-1    
M1900_PRIOR_ADLIADL_AMBLTN b-0 Independent   57251-1 LA12302-8 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_AMBLTN b-1 Needed Some Help   57251-1 LA12303-6 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_AMBLTN b-2 Dependent   57251-1 LA12304-4 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_TRNSFR c Prior Functioning ADL/IADL: Transfer   57252-9    
M1900_PRIOR_ADLIADL_TRNSFR c-0 Independent   57252-9 LA12302-8 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_TRNSFR c-1 Needed Some Help   57252-9 LA12303-6 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_TRNSFR c-2 Dependent   57252-9 LA12304-4 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_HSEHOLD d Prior Functioning ADL/IADL: Household Tasks   57253-7    
M1900_PRIOR_ADLIADL_HSEHOLD d-0 Independent   57253-7 LA12302-8 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_HSEHOLD d-1 Needed Some Help   57253-7 LA12303-6 1.3.6.1.4.1.12009.10.1.119
M1900_PRIOR_ADLIADL_HSEHOLD d-2 Dependent   57253-7 LA12304-4 1.3.6.1.4.1.12009.10.1.119
M1910_MLT_FCTR_FALL_RISK_ASMT   Has Patient Had A Multi-factor Fall Risk Assessment?   57254-5    
M1910_MLT_FCTR_FALL_RISK_ASMT 0 No multi-factor falls risk assessment conducted.   57254-5 LA12305-1 1.3.6.1.4.1.12009.10.1.120
M1910_MLT_FCTR_FALL_RISK_ASMT 1 Yes, and it does not indicate a risk for falls.   57254-5 LA12306-9 1.3.6.1.4.1.12009.10.1.120
M1910_MLT_FCTR_FALL_RISK_ASMT 2 Yes, and it indicates a risk for falls.   57254-5 LA12307-7 1.3.6.1.4.1.12009.10.1.120
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
MEDICATIONS          
M2000_DRUG_RGMN_RVW   Drug Regimen Review   57255-2    
M2000_DRUG_RGMN_RVW 0 Not assessed/reviewed   57255-2 LA12308-5 1.3.6.1.4.1.12009.10.1.121
M2000_DRUG_RGMN_RVW 1 No problems found during review   57255-2 LA12309-3 1.3.6.1.4.1.12009.10.1.121
M2000_DRUG_RGMN_RVW 2 Problems found during review   57255-2 LA12310-1 1.3.6.1.4.1.12009.10.1.121
M2000_DRUG_RGMN_RVW NA Patient is not taking any medications   57255-2 LA12311-9 1.3.6.1.4.1.12009.10.1.121
M2002_MDCTN_FLWP   Medication Follow-up   57281-8    
M2002_MDCTN_FLWP 0 No   57281-8 LA32-8 1.3.6.1.4.1.12009.10.1.62
M2002_MDCTN_FLWP 1 Yes   57281-8 LA33-6 1.3.6.1.4.1.12009.10.1.62
M2004_MDCTN_INTRVTN   Medication Intervention   57256-0    
M2004_MDCTN_INTRVTN 0 No   57256-0 LA32-8 1.3.6.1.4.1.12009.10.1.122
M2004_MDCTN_INTRVTN 1 Yes   57256-0 LA33-6 1.3.6.1.4.1.12009.10.1.122
M2004_MDCTN_INTRVTN NA No clinically significant medication issues identified since the previous OASIS assessment   57256-0 LA12314-3 1.3.6.1.4.1.12009.10.1.122
M2010_HIGH_RISK_DRUG_EDCTN   Patient/Caregiver High Risk Drug Education   57257-8    
M2010_HIGH_RISK_DRUG_EDCTN 0 No   57257-8 LA32-8 1.3.6.1.4.1.12009.10.1.123
M2010_HIGH_RISK_DRUG_EDCTN 1 Yes   57257-8 LA33-6 1.3.6.1.4.1.12009.10.1.123
M2010_HIGH_RISK_DRUG_EDCTN NA Patient not taking any high risk drugs OR patient/caregiver fully knowledgeable about special precautions associated with all high-risk medications   57257-8 LA12317-6 1.3.6.1.4.1.12009.10.1.123
M2015_DRUG_EDCTN_INTRVTN   Patient/Caregiver Drug Education Intervention   57195-0    
M2015_DRUG_EDCTN_INTRVTN 0 No   57195-0 LA32-8 1.3.6.1.4.1.12009.10.1.124
M2015_DRUG_EDCTN_INTRVTN 1 Yes   57195-0 LA33-6 1.3.6.1.4.1.12009.10.1.124
M2015_DRUG_EDCTN_INTRVTN NA Patient not taking any drugs   57195-0 LA12320-0 1.3.6.1.4.1.12009.10.1.124
M2020_CRNT_MGMT_ORAL_MDCTN   Current: Management Of Oral Medications   57285-9    
M2020_CRNT_MGMT_ORAL_MDCTN 0 Able to independently take the correct oral medication(s) and proper dosage(s) at the correct times.   57285-9 LA6135-3 1.3.6.1.4.1.12009.10.1.125
M2020_CRNT_MGMT_ORAL_MDCTN 1 Able to take medication(s) at the correct times if: (a) individual dosages are prepared in advance by another person; OR (b) another person develops a drug diary or chart.   57285-9 LA12322-6 1.3.6.1.4.1.12009.10.1.125
M2020_CRNT_MGMT_ORAL_MDCTN 2 Able to take medication(s) at the correct times if given reminders by another person at the appropriate times   57285-9 LA12323-4 1.3.6.1.4.1.12009.10.1.125
M2020_CRNT_MGMT_ORAL_MDCTN 3 Unable to take medication unless administered by another person.   57285-9 LA12324-2 1.3.6.1.4.1.12009.10.1.125
M2020_CRNT_MGMT_ORAL_MDCTN NA No oral medications prescribed.   57285-9 LA6290-6 1.3.6.1.4.1.12009.10.1.125
M2030_CRNT_MGMT_INJCTN_MDCTN   Current: Management Of Injectable Medications   57284-2    
M2030_CRNT_MGMT_INJCTN_MDCTN 0 Able to independently take the correct medication(s) and proper dosage(s) at the correct times.   57284-2 LA12326-7 1.3.6.1.4.1.12009.10.1.126
M2030_CRNT_MGMT_INJCTN_MDCTN 1 Able to take injectable medication(s) at the correct times if: (a) individual syringes are prepared in advance by another person; OR (b) another person develops a drug diary or chart.   57284-2 LA12327-5 1.3.6.1.4.1.12009.10.1.126
M2030_CRNT_MGMT_INJCTN_MDCTN 2 Able to take medication(s) at the correct times if given reminders by another person based on the frequency of the injection   57284-2 LA12328-3 1.3.6.1.4.1.12009.10.1.126
M2030_CRNT_MGMT_INJCTN_MDCTN 3 Unable to take injectable medication unless administered by another person.   57284-2 LA12329-1 1.3.6.1.4.1.12009.10.1.126
M2030_CRNT_MGMT_INJCTN_MDCTN NA No injectable medications prescribed.   57284-2 LA6280-7 1.3.6.1.4.1.12009.10.1.126
M2040_PRIOR_MGMT_ORAL_MDCTN a Prior Med Mgmt: Oral Medications   57258-6    
M2040_PRIOR_MGMT_ORAL_MDCTN a-0 Independent   57258-6 LA12302-8 1.3.6.1.4.1.12009.10.1.127
M2040_PRIOR_MGMT_ORAL_MDCTN a-1 Needed Some Help   57258-6 LA12303-6 1.3.6.1.4.1.12009.10.1.127
M2040_PRIOR_MGMT_ORAL_MDCTN a-2 Dependent   57258-6 LA12304-4 1.3.6.1.4.1.12009.10.1.127
M2040_PRIOR_MGMT_ORAL_MDCTN a-NA Not Applicable   57258-6 LA4720-4 1.3.6.1.4.1.12009.10.1.127
M2040_PRIOR_MGMT_INJCTN_MDCTN b Prior Med Mgmt: Injectable Medications   57259-4    
M2040_PRIOR_MGMT_INJCTN_MDCTN b-0 Independent   57259-4 LA12302-8 1.3.6.1.4.1.12009.10.1.127
M2040_PRIOR_MGMT_INJCTN_MDCTN b-1 Needed Some Help   57259-4 LA12303-6 1.3.6.1.4.1.12009.10.1.127
M2040_PRIOR_MGMT_INJCTN_MDCTN b-2 Dependent   57259-4 LA12304-4 1.3.6.1.4.1.12009.10.1.127
M2040_PRIOR_MGMT_INJCTN_MDCTN b-NA Not Applicable   57259-4 LA4720-4 1.3.6.1.4.1.12009.10.1.127
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
CARE MANAGEMENT          
M2100_CARE_TYPE_SRC_ADL a Care Mgmt, Types And Sources Of Assist: ADL   57260-2    
M2100_CARE_TYPE_SRC_ADL a-0 No assistance needed in this area   57260-2 LA12335-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADL a-1 Caregiver(s) currently provide assistance   57260-2 LA12336-6 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADL a-2 Caregiver(s) need training/ supportive services to provide assistance   57260-2 LA12337-4 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADL a-3 Caregiver(s) not likely to provide assistance   57260-2 LA12338-2 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADL a-4 Unclear if Caregiver(s) will provide assistance   57260-2 LA12339-0 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADL a-5 Assistance needed, but no Caregiver(s) available   57260-2 LA12340-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_IADL b Care Mgmt, Types And Sources Of Assist: IADL   57261-0    
M2100_CARE_TYPE_SRC_IADL b-0 No assistance needed in this area   57261-0 LA12335-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_IADL b-1 Caregiver(s) currently provide assistance   57261-0 LA12336-6 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_IADL b-2 Caregiver(s) need training/ supportive services to provide assistance   57261-0 LA12337-4 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_IADL b-3 Caregiver(s) not likely to provide assistance   57261-0 LA12338-2 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_IADL b-4 Unclear if Caregiver(s) will provide assistance   57261-0 LA12339-0 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_IADL b-5 Assistance needed, but no Caregiver(s) available   57261-0 LA12340-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_MDCTN c Care Mgmt, Types And Sources Of Assist: Medication Admin   57262-8    
M2100_CARE_TYPE_SRC_MDCTN c-0 No assistance needed in this area   57262-8 LA12335-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_MDCTN c-1 Caregiver(s) currently provide assistance   57262-8 LA12336-6 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_MDCTN c-2 Caregiver(s) need training/ supportive services to provide assistance   57262-8 LA12337-4 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_MDCTN c-3 Caregiver(s) not likely to provide assistance   57262-8 LA12338-2 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_MDCTN c-4 Unclear if Caregiver(s) will provide assistance   57262-8 LA12339-0 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_MDCTN c-5 Assistance needed, but no Caregiver(s) available   57262-8 LA12340-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_PRCDR d Care Mgmt, Types And Sources Of Assist: Med Procs Tx   57263-6    
M2100_CARE_TYPE_SRC_PRCDR d-0 No assistance needed in this area   57263-6 LA12335-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_PRCDR d-1 Caregiver(s) currently provide assistance   57263-6 LA12336-6 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_PRCDR d-2 Caregiver(s) need training/ supportive services to provide assistance   57263-6 LA12337-4 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_PRCDR d-3 Caregiver(s) not likely to provide assistance   57263-6 LA12338-2 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_PRCDR d-4 Unclear if Caregiver(s) will provide assistance   57263-6 LA12339-0 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_PRCDR d-5 Assistance needed, but no Caregiver(s) available   57263-6 LA12340-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_EQUIP e Care Mgmt, Types And Sources Of Assist: Equipment   57264-4    
M2100_CARE_TYPE_SRC_EQUIP e-0 No assistance needed in this area   57264-4 LA12335-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_EQUIP e-1 Caregiver(s) currently provide assistance   57264-4 LA12336-6 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_EQUIP e-2 Caregiver(s) need training/ supportive services to provide assistance   57264-4 LA12337-4 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_EQUIP e-3 Caregiver(s) not likely to provide assistance   57264-4 LA12338-2 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_EQUIP e-4 Unclear if Caregiver(s) will provide assistance   57264-4 LA12339-0 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_EQUIP e-5 Assistance needed, but no Caregiver(s) available   57264-4 LA12340-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_SPRVSN f Care Mgmt, Types And Sources Of Assist: Supervision And Safety   57265-1    
M2100_CARE_TYPE_SRC_SPRVSN f-0 No assistance needed in this area   57265-1 LA12335-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_SPRVSN f-1 Caregiver(s) currently provide assistance   57265-1 LA12336-6 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_SPRVSN f-2 Caregiver(s) need training/ supportive services to provide assistance   57265-1 LA12337-4 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_SPRVSN f-3 Caregiver(s) not likely to provide assistance   57265-1 LA12338-2 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_SPRVSN f-4 Unclear if Caregiver(s) will provide assistance   57265-1 LA12339-0 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_SPRVSN f-5 Assistance needed, but no Caregiver(s) available   57265-1 LA12340-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADVCY g Care Mgmt, Types And Sources Of Assist: Advocacy Or Facilitation   57266-9    
M2100_CARE_TYPE_SRC_ADVCY g-0 No assistance needed in this area   57266-9 LA12335-8 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADVCY g-1 Caregiver(s) currently provide assistance   57266-9 LA12336-6 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADVCY g-2 Caregiver(s) need training/ supportive services to provide assistance   57266-9 LA12337-4 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADVCY g-3 Caregiver(s) not likely to provide assistance   57266-9 LA12338-2 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADVCY g-4 Unclear if Caregiver(s) will provide assistance   57266-9 LA12339-0 1.3.6.1.4.1.12009.10.1.128
M2100_CARE_TYPE_SRC_ADVCY g-5 Assistance needed, but no Caregiver(s) available   57266-9 LA12340-8 1.3.6.1.4.1.12009.10.1.128
M2110_ADL_IADL_ASTNC_FREQ   How Often Recv ADL Or IADL Assistance From Any   57267-7    
M2110_ADL_IADL_ASTNC_FREQ 1 At least daily   57267-7 LA6157-7 1.3.6.1.4.1.12009.10.1.129
M2110_ADL_IADL_ASTNC_FREQ 2 Three or more times per week   57267-7 LA6396-1 1.3.6.1.4.1.12009.10.1.129
M2110_ADL_IADL_ASTNC_FREQ 3 One to two times per week   57267-7 LA6308-6 1.3.6.1.4.1.12009.10.1.129
M2110_ADL_IADL_ASTNC_FREQ 4 Received, but less often than weekly   57267-7 LA12344-0 1.3.6.1.4.1.12009.10.1.129
M2110_ADL_IADL_ASTNC_FREQ 5 No assistance received   57267-7 LA12345-7 1.3.6.1.4.1.12009.10.1.129
M2110_ADL_IADL_ASTNC_FREQ UK Unknown   57267-7 LA4489-6 1.3.6.1.4.1.12009.10.1.129
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
THERAPY NEED AND PLAN OF CARE          
M2200_THER_NEED_NUM   Therapy Need: Number of Visits   57268-5    
M2200_THER_NEED_NA   Therapy Need: Not Applicable        
M2250_PLAN_SMRY_PTNT_SPECF a Plan Of Care Synopsis: Patient Specific Parameters   57269-3    
M2250_PLAN_SMRY_PTNT_SPECF a-0 No   57269-3 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PTNT_SPECF a-1 Yes   57269-3 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PTNT_SPECF a-NA Physician has chosen not to establish patient -specific parameters for this patient. Agency will use standardized clinical guidelines accessible for all care providers to reference.   57269-3 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_DBTS_FT_CARE b Plan Of Care Synopsis: Diabetic Foot Care   57270-1    
M2250_PLAN_SMRY_DBTS_FT_CARE b-0 No   57270-1 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_DBTS_FT_CARE b-1 Yes   57270-1 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_DBTS_FT_CARE b-NA Patient is not diabetic or is bilateral amputee.   57270-1 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_FALL_PRVNT c Plan Of Care Synopsis: Falls Prevention Interventions   57271-9    
M2250_PLAN_SMRY_FALL_PRVNT c-0 No   57271-9 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_FALL_PRVNT c-1 Yes   57271-9 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_FALL_PRVNT c-NA Patient is not assessed to be at risk for falls.   57271-9 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_DPRSN_INTRVTN d Plan Of Care Synopsis: Depression Interventions   57272-7    
M2250_PLAN_SMRY_DPRSN_INTRVTN d-0 No   57272-7 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_DPRSN_INTRVTN d-1 Yes   57272-7 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_DPRSN_INTRVTN d-NA Patient has not diagnosis or symptoms of depression.   57272-7 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PAIN_INTRVTN e Plan Of Care Synopsis: Pain Interventions   57273-5    
M2250_PLAN_SMRY_PAIN_INTRVTN e-0 No   57273-5 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PAIN_INTRVTN e-1 Yes   57273-5 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PAIN_INTRVTN e-NA No pain identified   57273-5 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PRSULC_PRVNT f Plan Of Care Synopsis: PU Prevention   57274-3    
M2250_PLAN_SMRY_PRSULC_PRVNT f-0 No   57274-3 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PRSULC_PRVNT f-1 Yes   57274-3 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PRSULC_PRVNT f-NA Patient is not assessed to be at risk for pressure ulcers.   57274-3 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PRSULC_TRTMT g Plan Of Care Synopsis: PU Moist Treatment   57275-0    
M2250_PLAN_SMRY_PRSULC_TRTMT g-0 No   57275-0 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PRSULC_TRTMT g-1 Yes   57275-0 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2250_PLAN_SMRY_PRSULC_TRTMT g-NA Patient has no pressure ulcers with need for moist wound healing.   57275-0 LA4720-4 1.3.6.1.4.1.12009.10.1.130
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
EMERGENT CARE          
M2300_EMER_USE_AFTR_LAST_ASMT   Emergent Care: Use Since Last Oasis Data Collection   57276-8    
M2300_EMER_USE_AFTR_LAST_ASMT 0 No   0 LA32-8 1.3.6.1.4.1.12009.10.1.131
M2300_EMER_USE_AFTR_LAST_ASMT 1 Yes, used hospital emergency department WITHOUT hospital admission   1 LA12351-5 1.3.6.1.4.1.12009.10.1.131
M2300_EMER_USE_AFTR_LAST_ASMT 2 Yes, used hospital emergency department WITH hospital admission   2 LA12352-3 1.3.6.1.4.1.12009.10.1.131
M2300_EMER_USE_AFTR_LAST_ASMT UK Unknown   UK LA4489-6 1.3.6.1.4.1.12009.10.1.131
M2310   Reason for emergent care Question row added to facilitate message format. 57277-6    
M2310_ECR_MEDICATION 1 Emergent Care Reason: Medication   57277-6 LA6229-4 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_INJRY_BY_FALL 2 Emergent Care Reason: Injury Caused By Fall   57277-6 LA12355-6 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_RSPRTRY_INFCTN 3 Emergent Care Reason: Respiratory Infection   57277-6 LA12356-4 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_RSPRTRY_OTHR 4 Emergent Care Reason: Respiratory Other   57277-6 LA12357-2 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_HRT_FAILR 5 Emergent Care Reason: Heart Failure   57277-6 LA12358-0 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_CRDC_DSRTHM 6 Emergent Care Reason: Cardiac Dysrhythmia   57277-6 LA12359-8 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_MI_CHST_PAIN 7 Emergent Care Reason: Myocardial Infarction Or Chest Pain   57277-6 LA12360-6 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_OTHR_HRT_DEASE 8 Emergent Care Reason: Other Heart Disease   57277-6 LA12361-4 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_STROKE_TIA 9 Emergent Care Reason: Stroke (CVA) Or TIA   57277-6 LA12362-2 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_HYPOGLYC 10 Emergent Care Reason: Hypoglycemia   57277-6 LA6223-7 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_GI_PRBLM 11 Emergent Care: GI Bleeding, Obstruction, Constipation, Impaction   57277-6 LA12364-8 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_DHYDRTN_MALNTR 12 Emergent Care Reason: Dehydration, Malnutrition   57277-6 LA12365-5 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_UTI 13 Emergent Care Reason: Urinary Track Infection   57277-6 LA6437-3 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_CTHTR_CMPLCTN 14 Emergent Care Reason: IV Catheter-related Infection Or Complication   57277-6 LA12367-1 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_WND_INFCTN_DTRORTN 15 Emergent Care Reason: Wound Infection Or Deterioration   57277-6 LA12368-9 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_UNCNTLD_PAIN 16 Emergent Care Reason: Uncontrolled Pain   57277-6 LA6430-8 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_MENTL_BHVRL_PRBLM 17 Emergent Care Reason: Acute Mental/Behavioral Health Problem   57277-6 LA12370-5 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_DVT_PULMNRY 18 Emergent Care Reason: Deep Vein Thrombosis, Pulmonary Embolus   57277-6 LA6180-9 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_OTHER 19 Emergent Care Reason: Other Than Above   57277-6 LA6315-1 1.3.6.1.4.1.12009.10.1.132
M2310_ECR_UNKNOWN UK Emergent Care Reason: Unknown   57277-6 LA4394-8 1.3.6.1.4.1.12009.10.1.132
CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
General Guidance LOINC Question Code LOINC Answer Code LOINC Answer Set OID
DATA ITEMS COLLECTED AT INPATIENT FACILITY ADMISSION OR AGENCY DISCHARGE ONLY          
M2400_INTRVTN_SMRY_DBTS_FT a Intervention Synopsis: Diabetic Foot Care   57270-1    
M2400_INTRVTN_SMRY_DBTS_FT a-0 No   57270-1 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_DBTS_FT a-1 Yes   57270-1 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_DBTS_FT a-NA Patient is not diabetic or is bilateral amputee   57270-1 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_FALL_PRVNT b Intervention Synopsis: Falls Prevention Intervention   57271-9    
M2400_INTRVTN_SMRY_FALL_PRVNT b-0 No   57271-9 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_FALL_PRVNT b-1 Yes   57271-9 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_FALL_PRVNT b-NA Formal multi-factor Fall Risk Assessment indicates the patient was not at risk for falls since the last OASIS assessment   57271-9 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_DPRSN c Intervention Synopsis: Depression Intervention   57272-7    
M2400_INTRVTN_SMRY_DPRSN c-0 No   57272-7 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_DPRSN c-1 Yes   57272-7 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_DPRSN c-NA Formal assessment indicates patient did not meet criteria for depression AND patient did not have diagnosis of depression since the last OASIS assessment   57272-7 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PAIN_MNTR d Intervention Synopsis: Intervention To Monitor And Mitigate Pain   57273-5    
M2400_INTRVTN_SMRY_PAIN_MNTR d-0 No   57273-5 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PAIN_MNTR d-1 Yes   57273-5 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PAIN_MNTR d-NA Formal assessment did not indicate pain since the last OASIS asessment   57273-5 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PRSULC_PRVN e Intervention Synopsis: Intervention To Prevent Pressure Ulcers   57274-3    
M2400_INTRVTN_SMRY_PRSULC_PRVN e-0 No   57274-3 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PRSULC_PRVN e-1 Yes   57274-3 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PRSULC_PRVN e-NA Formal assessment indicates the patient was not at risk of pressure ulcers since the last OASIS assessment   57274-3 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PRSULC_WET f Intervention Synopsis: Pressure Ulcer Treatment Based On Moist Wound Treatment   57275-0    
M2400_INTRVTN_SMRY_PRSULC_WET f-0 No   57275-0 LA32-8 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PRSULC_WET f-1 Yes   57275-0 LA33-6 1.3.6.1.4.1.12009.10.1.130
M2400_INTRVTN_SMRY_PRSULC_WET f-NA Dressings that support the principles of moist wound healing not indicated for this patient's pressure ulcers OR patient has no pressure ulcers with need for moist would healing   57275-0 LA4720-4 1.3.6.1.4.1.12009.10.1.130
M2410_INPAT_FACILITY   Inpatient Facility   46578-1    
M2410_INPAT_FACILITY 1 Hospital   46578-1 LA6218-7 1.3.6.1.4.1.12009.10.1.156
M2410_INPAT_FACILITY 2 Rehabilitation facility   46578-1 LA6357-3 1.3.6.1.4.1.12009.10.1.156
M2410_INPAT_FACILITY 3 Nursing home   46578-1 LA27-8 1.3.6.1.4.1.12009.10.1.156
M2410_INPAT_FACILITY 4 Hospice   46578-1 LA6216-1 1.3.6.1.4.1.12009.10.1.156
M2410_INPAT_FACILITY NA No inpatient facility admission   46578-1 LA6281-5 1.3.6.1.4.1.12009.10.1.156
M2420_DSCHRG_DISP   Discharge Disposition   57278-4    
M2420_DSCHRG_DISP 1 Patient remained in the community (without formal assistive services)   57278-4 LA12374-7 1.3.6.1.4.1.12009.10.1.133
M2420_DSCHRG_DISP 2 Patient remained in the community (with formal assistive services)   57278-4 LA12375-4 1.3.6.1.4.1.12009.10.1.133
M2420_DSCHRG_DISP 3 Patient transferred to a non-institutional hospice   57278-4 LA12376-2 1.3.6.1.4.1.12009.10.1.133
M2420_DSCHRG_DISP 4 Unknown because patient moved to a geographic location not served by this agency   57278-4 LA6431-6 1.3.6.1.4.1.12009.10.1.133
M2420_DSCHRG_DISP UK Other unknown   57278-4 LA6316-9 1.3.6.1.4.1.12009.10.1.133
M2430   Reason for hospitalization Question row added to facilitate message format. 57279-2    
M2430_HOSP_MED 1 Hospitalized: Medication   57279-2 LA6229-4 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_INJRY_BY_FALL 2 Hospitalized: Injury Caused By Fall   57279-2 LA12355-6 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_RSPRTRY_INFCTN 3 Hospitalized: Respiratory   57279-2 LA12356-4 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_RSPRTRY_OTHR 4 Hospitalized: Other Respiratory   57279-2 LA12357-2 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_HRT_FAILR 5 Hospitalized: Heart Failure   57279-2 LA12358-0 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_CRDC_DSRTHM 6 Hospitalized: Cardiac Dysrhythmia   57279-2 LA12359-8 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_MI_CHST_PAIN 7 Hospitalized: Myocardial Infarction Or Chest Pain   57279-2 LA12360-6 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_OTHR_HRT_DEASE 8 Hospitalized: Other Heart Disease   57279-2 LA12361-4 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_STROKE_TIA 9 Hospitalized: Stroke (CVA) Or TIA   57279-2 LA12362-2 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_HYPOGLYC 10 Hospitalized: Hypoglycemia   57279-2 LA6223-7 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_GI_PRBLM 11 Hospitalized: GI Bleeding, Obstruction, Constipation, Impaction   57279-2 LA12364-8 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_DHYDRTN_MALNTR 12 Hospitalized: Dehydration, Malnutrition   57279-2 LA12365-5 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_UR_TRACT 13 Hospitalized: Urinary Tract   57279-2 LA6437-3 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_CTHTR_CMPLCTN 14 Hospitalized: IV Catheter Related Infection Or Complication   57279-2 LA12367-1 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_WND_INFCTN 15 Hospitalized: Wound Infection Or Deterioration   57279-2 LA12368-9 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_PAIN 16 Hospitalized: Pain   57279-2 LA6430-8 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_MENTL_BHVRL_PRBLM 17 Hospitalized: Acute Mental/Behavior Health Problem   57279-2 LA12370-5 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_DVT_PULMNRY 18 Hospitalized: Deep vein thrombosis, Pulmonary embolus   57279-2 LA6180-9 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_SCHLD_TRTMT 19 Hospitalized: Scheduled Treatment Or Procedure   57279-2 LA12397-8 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_OTHER 20 Hospitalized: Other   57279-2 LA6315-1 1.3.6.1.4.1.12009.10.1.134
M2430_HOSP_UK UK Hospitalized: UK        
M2440   Reason for nursing home admission Question row added to facilitate message format. 46477-6    
M2440_NH_THERAPY 1 Admitted to Nursing Home: Therapy   46477-6 LA6393-8 1.3.6.1.4.1.12009.10.1.157
M2440_NH_RESPITE 2 Admitted to Nursing Home: Respite   46477-6 LA6365-6 1.3.6.1.4.1.12009.10.1.157
M2440_NH_HOSPICE 3 Admitted to Nursing Home: Hospice   46477-6 LA6217-9 1.3.6.1.4.1.12009.10.1.157
M2440_NH_PERMANENT 4 Admitted to Nursing Home: Permanent Placement   46477-6 LA6345-8 1.3.6.1.4.1.12009.10.1.157
M2440_NH_UNSAFE_HOME 5 Admitted to Nursing Home: Unsafe at Home   46477-6 LA6434-0 1.3.6.1.4.1.12009.10.1.157
M2440_NH_OTHER 6 Admitted to Nursing Home: Other   46477-6 LA46-8 1.3.6.1.4.1.12009.10.1.157
M2440_NH_UNKNOWN UK Admitted to Nursing Home: Unknown   46477-6 LA4489-6 1.3.6.1.4.1.12009.10.1.157
M0903_LAST_HOME_VISIT   Date of Last Home Visit   46581-5    
M0906_DC_TRAN_DTH_DT   Discharge, Transfer, Death Date   46582-3    

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