M1700 — Cognitive Functioning
Response options, how to score it, and the error that most often sends the record back. Cited to Ch. 3, Item M1700.
Response options
| Value | Meaning |
|---|---|
| 0 | Alert/oriented, able to focus and shift attention, comprehends and recalls task directions independently. |
| 1 | Requires prompting (cueing, repetition, reminders) only under stressful or unfamiliar conditions. |
| 2 | Requires assistance and some direction in specific situations (for example, on all tasks involving shifting of attention) or consistently requires low stimulus environment due to distractibility. |
| 3 | Requires considerable assistance in routine situations. Is not alert and oriented or is unable to shift attention and recall directions more than half the time. |
| 4 | Totally dependent due to disturbances such as constant disorientation, coma, persistent vegetative state, or delirium. |
How to score it
Assess the patient's current level (day of assessment, considering the preceding 24 hours) of alertness, orientation, comprehension, concentration, and immediate memory for simple commands — interview the patient and/or caregiver and review referral information. Consider both the signs/symptoms of cognitive dysfunction observed and the amount of supervision/care those deficits require. Dash is not a valid response for this item.
The common error
Coding from a documented diagnosis (for example dementia) alone rather than the patient's actual current functional presentation — CMS's coding tip notes several diagnoses (dementia, delirium, developmental delay, stroke-related deficits, opioid therapy) can produce cognitive dysfunction, but the code must reflect the patient's observed alertness/orientation/comprehension that day, not the diagnosis itself.
Source: OASIS-E2 Guidance Manual — Ch. 3, Item M1700. Verified 2026-04-26.
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