Form Coding Instructions

(M1020/1022/1024) Diagnoses, Symptom Control, and Payment Diagnoses: List each diagnosis for which the patient is receiving home care (Column 1) and enter its ICD-9-C M code at the level of highest specificity (no surgical/procedure codes) (Column 2). Diagnoses are listed in the order that best reflect the seriousness of each condition and support the disciplines and services provided. Rate the degree of symptom control for each condition (Column 2). Choose one value that represents the degree of symptom control appropriate for each diagnosis: V-codes (for M1020 or M1022) or E-codes (for M1022 only) may be used. ICD-9-C M sequencing requirements must be followed if multiple coding is indicated for any diagnoses. If a V-code is reported in place of a case mix diagnosis, then optional item M1024 Payment Diagnoses (Columns 3 and 4) may be completed. A case mix diagnosis is a diagnosis that determines the Medicare P P S case mix group. Do not assign symptom control ratings for V- or E-codes. Code each row according to the following directions for each column: Column 1: Enter the description of the diagnosis.Diagnoses (Sequencing of diagnoses should reflect the seriousness of each condition and support the disciplines and services provided.) Column 2: Enter the ICD-9-C M code for the diagnosis described in Column 1; Rate the degree of symptom control for the condition listed in Column 1 using the following scale: 0 - Asymptomatic, no treatment needed at this time 1 - Symptoms well controlled with current therapy 2 - Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring 3 - Symptoms poorly controlled; patient needs frequent adjustment in treatment and dose monitoring 4 - Symptoms poorly controlled; history of re-hospitalizations Note that in Column 2 the rating for symptom control of each diagnosis should not be used to determine the sequencing of the diagnoses listed in Column 1. These are separate items and sequencing may not coincide. Sequencing of diagnoses should reflect the seriousness of each condition and support the disciplines and services provided.ICD-9-C M and symptom control rating for each condition. Note that the sequencing of these ratings may not match the sequencing of Column 3: (OPTIONAL) If a V-code is assigned to any row in Column 2, in place of a case mix diagnosis, it may be necessary to complete optional item M1024 Payment Diagnoses (Columns 3 and 4). See OASIS-C Guidance Manual.Complete if a V-code is assigned under certain circumstances to Column 2 in place of a case mix diagnosis. Column 4: (OPTIONAL) If a V-code in Column 2 is reported in place of a case mix diagnosis that requires multiple diagnosis codes under ICD-9-C M coding guidelines, enter the diagnosis descriptions and the ICD-9-C M codes in the same row in Columns 3 and 4. For example, if the case mix diagnosis is a manifestation code, record the diagnosis description and ICD-9-C M code for the underlying condition in Column 3 of that row and the diagnosis description and ICD-9-C M code for the manifestation in Column 4 of that row. Otherwise, leave Column 4 blank in that row.Complete only if the V-code in Column 2 is reported in place of a case mix diagnosis that is a multiple coding situation (e.g., a manifestation code)

Source: Centers for Medicare & Medicaid Services

86255-7 Primary diagnosis ICD code

Term Description

The condition that is the chief reason for providing care.

Fully-Specified Name

Component
Primary diagnosis ICD code
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

Class
CLIN
Type
Clinical
First Released
Version 2.63
Last Updated
Version 2.73 (MIN)
Order vs. Observation
Both
Common Test Rank Get Info
17680

Example Answer List LL4547-7

Externally Defined
Yes
Code System
Code System OID
1.3.6.1.4.1.12009.10.1.3459
Link to External List
http://www.cdc.gov/nchs/icd.htm

Member of these Panels

LOINCLong Common Name
76464-7American Physical Therapy Association registry panel
52747-3Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
69412-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care
86244-1Deprecated Outcome and assessment information set (OASIS) form - version C2 - Follow-up - recertification or other follow-up [CMS Assessment]
86189-8Deprecated Outcome and assessment information set (OASIS) form - version C2 - Resumption of care [CMS Assessment]
85907-4Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment]
88369-4Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88368-6Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99160-4Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106525-9Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]

Language Variants Get Info

TagLanguageTranslation
el-GRGreek (Greece)Κωδικός ICD κύριας διάγνωσης:Type:Pt:^Ασθενής:Nom:
Synonyms: - CLIN Nom Pt Type Ασθενής Διάγνωση Κωδικός ICD διάγνωσης Κωδικός ICD κύριας διάγνωσης
es-MXSpanish (Mexico)Código ICD de diagnóstico primario:Tipo:Punto temporal:^ Paciente:Nominal:
it-ITItalian (Italy)Diagnosi primaria codice ICD:Tipo:Pt:^Paziente:Nom:
Synonyms: Clinico paziente Punto nel tempo (episodio)
zh-CNChinese (China)主要诊断 ICD 代码:类型:时间点:^患者:名义型:
Synonyms: ICD 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 医疗服务对象;客户;病人;病患;病号;超系统 - 病人 国际疾病分类(International Classification of Diseases,ICD) 国际疾病分类;international Classification of diseases;ICD 国际疾病分类法 国际疾病分类系统 型 时刻;随机;随意;瞬间 诊断 ICD 编码;ICD 诊断代码;ICD 诊断编码;国际疾病分类;international Classification of diseases;ICD 诊断结论;判断;结论

46512-0 Primary Diagnosis Symptom Control Rating

Term Description

Severity category for diagnosis.

Observation ID in Form

M1020

Fully-Specified Name

Component
Primary diagnosis severity rating
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
OASIS

Long Common Name

Primary diagnosis severity rating [OASIS]

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.50 (MIN)

Normative Answer List LL253-6

AnswerCodeScoreAnswer ID
00LA6111-4
11LA6112-2
2 or more2LA6113-0
33LA6114-8
44LA6115-5

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46513-8 Other diagnosis 1 - ICD code [OASIS]

Term Description

Identifies diagnosis for which the patient is receiving care and its ICD-9-CM code.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 1 - ICD code
Property
Prid
Time
Pt
System
^Patient
Scale
Nom
Method
OASIS

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL343-5

Externally Defined
Yes
Code System
I9C
Code System OID
1.3.6.1.4.1.12009.10.1.2173
Link to External List

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46514-6 Other diagnosis 1: Symptom Control Rating

Term Description

Severity category for diagnosis.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 1 - severity rating
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
OASIS

Long Common Name

Other diagnosis 1 - severity rating [OASIS]

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL253-6

AnswerCodeScoreAnswer ID
00LA6111-4
11LA6112-2
2 or more2LA6113-0
33LA6114-8
44LA6115-5

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46515-3 Other diagnosis 2 - ICD code [OASIS]

Term Description

Identifies diagnosis for which the patient is receiving care and its ICD-9-CM code.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 2 - ICD code
Property
Prid
Time
Pt
System
^Patient
Scale
Nom
Method
OASIS

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL343-5

Externally Defined
Yes
Code System
I9C
Code System OID
1.3.6.1.4.1.12009.10.1.2173
Link to External List

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46516-1 Other diagnosis 2: Symptom Control Rating

Term Description

Severity category for diagnosis.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 2 - severity rating
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
OASIS

Long Common Name

Other diagnosis 2 - severity rating [OASIS]

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL253-6

AnswerCodeScoreAnswer ID
00LA6111-4
11LA6112-2
2 or more2LA6113-0
33LA6114-8
44LA6115-5

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46517-9 Other diagnosis 3 - ICD code [OASIS]

Term Description

Identifies diagnosis for which the patient is receiving care and its ICD-9-CM code.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 3 - ICD code
Property
Prid
Time
Pt
System
^Patient
Scale
Nom
Method
OASIS

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL343-5

Externally Defined
Yes
Code System
I9C
Code System OID
1.3.6.1.4.1.12009.10.1.2173
Link to External List

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46518-7 Other diagnosis 3: Symptom Control Rating

Term Description

Severity category for diagnosis.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 3 - severity rating
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
OASIS

Long Common Name

Other diagnosis 3 - severity rating [OASIS]

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL253-6

AnswerCodeScoreAnswer ID
00LA6111-4
11LA6112-2
2 or more2LA6113-0
33LA6114-8
44LA6115-5

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46519-5 Other diagnosis 4 - ICD code [OASIS]

Term Description

Identifies diagnosis for which the patient is receiving care and its ICD-9-CM code.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 4 - ICD code
Property
Prid
Time
Pt
System
^Patient
Scale
Nom
Method
OASIS

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL343-5

Externally Defined
Yes
Code System
I9C
Code System OID
1.3.6.1.4.1.12009.10.1.2173
Link to External List

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46520-3 Other diagnosis 4: Symptom Control Rating

Term Description

Severity category for diagnosis.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 4 - severity rating
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
OASIS

Long Common Name

Other diagnosis 4 - severity rating [OASIS]

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL253-6

AnswerCodeScoreAnswer ID
00LA6111-4
11LA6112-2
2 or more2LA6113-0
33LA6114-8
44LA6115-5

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46521-1 Other diagnosis 5 - ICD code [OASIS]

Term Description

Identifies diagnosis for which the patient is receiving care and its ICD-9-CM code.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 5 - ICD code
Property
Prid
Time
Pt
System
^Patient
Scale
Nom
Method
OASIS

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL343-5

Externally Defined
Yes
Code System
I9C
Code System OID
1.3.6.1.4.1.12009.10.1.2173
Link to External List

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

46522-9 Other diagnosis 5: Symptom Control Rating

Term Description

Severity category for diagnosis.

Observation ID in Form

M1022

Fully-Specified Name

Component
Other diagnosis 5 - severity rating
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
OASIS

Long Common Name

Other diagnosis 5 - severity rating [OASIS]

Basic Attributes

Class
SURVEY.OASIS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.54 (MIN)

Normative Answer List LL253-6

AnswerCodeScoreAnswer ID
00LA6111-4
11LA6112-2
2 or more2LA6113-0
33LA6114-8
44LA6115-5

Member of these Panels

LOINCLong Common Name
46462-8Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care