1️⃣ M1033 – Risk for Hospitalization

Why auditors target it

This item drives multiple risk adjustment components used in outcome and HHVBP measures.

Surveyors frequently find:

• Risk factors checked without documentation support
   
• Missing clinical evidence for items like:
  
  • ≥2 hospitalizations
     
  • frailty indicators
     
  • polypharmacy
     
  • falls history
     

Example citation

OASIS indicates fall risk but:

• no falls documented
   
• no gait instability
   
• no balance assessment
   

➡ considered unsupported risk coding

2️⃣ GG0170 – Functional Mobility / Self-Care

This includes:

• transfers
   
• ambulation
   
• toileting
   
• dressing
   

These items are heavily audited because they affect:

• Quality measures
   
• Risk adjustment
   
• functional outcome scores
   

Most common problem

Nursing and therapy documentation do not match.

Example:

OASIS:
Patient requires max assist for transfers

Therapy notes:
Patient independent

➡ OASIS considered invalid

3️⃣ J1900 – Falls Since SOC/ROC

This item is commonly audited because:

• falls affect hospitalization risk measures
   
• falls influence quality reporting
   

Common issues:

• fall reported in narrative but not coded in OASIS
   
• fall coded in OASIS but not documented anywhere
   

OASIS-E2 also revised injury definitions, which auditors will review carefully. final-oasis-e2-change-table

4️⃣ M1021 / M1023 – Primary & Secondary Diagnoses

These items drive:

• PDGM case mix
   
• clinical grouping
   
• risk adjustment
   

Auditors frequently find:

• diagnoses not supported by documentation
   
• resolved conditions coded
   
• hospital discharge diagnoses copied without relevance
   

CMS specifically states only active conditions affecting care should be coded. OASIS E2

5️⃣ M1860 – Ambulation

This is one of the highest-risk items in all of OASIS.

Why?

Because it affects:

• functional outcomes
   
• HHVBP measures
   
• therapy necessity
   

Most common findings:

• ambulation coded worse than documentation supports
   
• mobility inconsistent with therapy notes
   
• assist level exaggerated
   

Example:

OASIS:
Patient requires two-person assist

Therapy:
Patient walked 150 ft with walker

➡ documentation conflict

Why These 5 Items Cause Most Problems

They impact three major CMS systems simultaneously:

Item TypeImpactRisk adjustmentQuality measuresFunctional scoringHHVBPDiagnosis codingPDGM case mix 

That makes them prime targets during audits.

What I Tell Agencies to Audit First

If an agency wants to reduce ADR risk quickly, audit:

1️⃣ M1033 hospitalization risk
2️⃣ Functional scoring (GG items)
3️⃣ Ambulation M1860
4️⃣ Falls J1900
5️⃣ Diagnosis coding

Those five items reveal most OASIS accuracy problems.