Question 1

M1033. When a clinician is responding to M1033 - Risk for Hospitalization, how should exhaustion be defined for response 8 - Currently reports exhaustion? Does this refer to mental or physical exhaustion, or both?

Accepted Answer

The assessing clinician may consider both physical and/or mental exhaustion when responding to M1033 - Risk for Hospitalization. Note that the information can be gathered by report and refers to the patient’s “current” (day of assessment) status.

Question 2

M1033. For M1033 - Risk of Hospitalization, if my patient is discharged from the acute care hospital in the morning and readmitted to the acute care hospital that same day, is that counted as two acute care hospital admissions?

Accepted Answer

Yes, if the patient is discharged from an acute care hospital in the morning and readmitted to an acute care hospital that same day and both hospitalizations meet the definition for an acute care hospitalization, that is counted as two hospitalizations. Observation stays are excluded.

Question 3

M1033. For M1033 - Risk for Hospitalization, Response 7 - Currently taking 5 or more medications, does this include medications that the patient is not taking due to non-compliance? For example, we have a patient that is prescribed 8 medications but is only actually taking 3 because of non-compliance with the other 5. Would we select Response 7 because the patient is prescribed more than 5 medications, even though the patient is not taking more than 5 medications?

Accepted Answer

For M1033 - Risk for Hospitalization, medications include prescribed and over the counter (OTC) medications, nutritional supplements, vitamins, and homeopathic and herbal products administered by any route and as noted on the reconciled medication profile. Medications may also include total parenteral nutrition (TPN) and oxygen (as defined in M2001 Drug Regimen Review). In your scenario, if your patient has 8 medications on their reconciled medication profile, M1033 – Risk for Hospitalization coding would include “Response 7 - Currently taking 5 or more medications,” even if the patient is not consistently taking the medication as prescribed.

Question 4

M1033. For M1033 - Risk for Hospitalization does the time period under consideration or “look back” period include the day of assessment?

Accepted Answer

M1033 - Risk for Hospitalization identifies patient characteristics that may indicate the patient is at risk for hospitalization. The time period under consideration or “look back” for responses 1 through 8 includes the day of assessment. Day of assessment is defined as the 24 hours immediately preceding the assessment and the time spent by the clinician conducting the assessment.

Question 5

M1033. If a patient is sent from one hospital Emergency Department (ED) to another does this count as one or two ED visits for M1033 - Risk for Hospitalizations, response 4 - Multiple Emergency Department Visits?

Accepted Answer

M1033 - Risk for Hospitalization, response 4 - Multiple Emergency Department Visits only includes hospital emergency department visits. If a patient is transferred from one hospital emergency department to a second hospital emergency department, this is counted as two emergency department visits.

Question 6

M1033, J1800, J1900. For OASIS coding, if a patient has a seizure which causes them to fall and sustain a subdural hematoma, is this considered a fall with major injury?

Accepted Answer

Falls that occur due to a medical event, such as a seizure, are considered a fall for the purposes of coding M1033 - Risk for Hospitalization, J1800 - Any Falls Since SOC/ROC and J1900 - Number of Falls since SOC/ROC.

Question 7

What is the definition of an “injury” for M1033 - Risk of Hospitalization, response 1 History of falls (2 or more falls - or any fall with injury - in the past 12 months)?

Accepted Answer

M1033 - Risk for Hospitalization identifies patient characteristics that may indicate the patient is at risk for hospitalization. To check M1033, response 1 - History of falls (2 or more falls - or any fall with injury - in the past 12 months), the patient must have had two or more falls or any fall with an injury in the past 12 months. To check M1033, response 1, HHAs should refer to the definitions of injury related to a fall in J1900 Number of Falls Since SOC/ROC when determining if a fall with an injury occurred. For M1033, a fall with an injury indicates that there was any reported injury (major injury and/or injury except major) within the past 12 months that occurred as a result of or was recognized within a short period of time (e.g., hours to a few days) after the fall and attributed to the fall.

Question 8

If, in the past 12 months, a patient had one fall and was then diagnosed with a fracture that was confirmed to be pathological due to osteoporosis, would M1033 - Risk for Hospitalization, response 1 - History of falls (2 or more falls - or any fall with an injury - in the past 12 months) be checked?

Accepted Answer

M1033 - Risk for Hospitalization identifies patient characteristics that may indicate the patient is at risk for hospitalization. To check M1033, response 1 - History of falls (2 or more falls - or any fall with injury - in the past 12 months) the patient must have had two or more falls or any fall with an injury in the past 12 months. M1033 utilizes the same definition of “injury related to a fall” as J1900 - Number of Falls since SOC/ROC. Therefore, if the fracture was determined to be pathological in nature, then the fall did not result in an injury, and it would not be considered as a fall with injury.

M1033: CMS OASIS Q&As

M1033. When a clinician is responding to M1033 - Risk for Hospitalization, how should exhaustion be defined for response 8 - Currently reports exhaustion? Does this refer to mental or physical exhaustion, or both?

M1033. For M1033 - Risk of Hospitalization, if my patient is discharged from the acute care hospital in the morning and readmitted to the acute care hospital that same day, is that counted as two acute care hospital admissions?

M1033. For M1033 - Risk for Hospitalization does the time period under consideration or “look back” period include the day of assessment?

M1033. If a patient is sent from one hospital Emergency Department (ED) to another does this count as one or two ED visits for M1033 - Risk for Hospitalizations, response 4 - Multiple Emergency Department Visits?

M1033, J1800, J1900. For OASIS coding, if a patient has a seizure which causes them to fall and sustain a subdural hematoma, is this considered a fall with major injury?

Since the February 2026 release: July 2026 CMS Quarterly OASIS Q&As

What is the definition of an “injury” for M1033 - Risk of Hospitalization, response 1 History of falls (2 or more falls - or any fall with injury - in the past 12 months)?

If, in the past 12 months, a patient had one fall and was then diagnosed with a fracture that was confirmed to be pathological due to osteoporosis, would M1033 - Risk for Hospitalization, response 1 - History of falls (2 or more falls - or any fall with an injury - in the past 12 months) be checked?

M1033: CMS OASIS Q&As

M1033. When a clinician is responding to M1033 - Risk for Hospitalization, how should exhaustion be defined for response 8 - Currently reports exhaustion? Does this refer to mental or physical exhaustion, or both?

M1033. For M1033 - Risk of Hospitalization, if my patient is discharged from the acute care hospital in the morning and readmitted to the acute care hospital that same day, is that counted as two acute care hospital admissions?

M1033. For M1033 - Risk for Hospitalization does the time period under consideration or “look back” period include the day of assessment?

M1033. If a patient is sent from one hospital Emergency Department (ED) to another does this count as one or two ED visits for M1033 - Risk for Hospitalizations, response 4 - Multiple Emergency Department Visits?

M1033, J1800, J1900. For OASIS coding, if a patient has a seizure which causes them to fall and sustain a subdural hematoma, is this considered a fall with major injury?

Since the February 2026 release: July 2026 CMS Quarterly OASIS Q&As

What is the definition of an “injury” for M1033 - Risk of Hospitalization, response 1 History of falls (2 or more falls - or any fall with injury - in the past 12 months)?

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