Reference Guide

OASIS M1800-M1860: How to Score the ADL Items

Grooming, dressing, bathing, toilet transferring, transferring, and ambulation. Here is what each OASIS-E2 item measures, how its response scale works, where coders and clinicians go wrong, and why these seven items set the PDGM functional level.

📅 Updated October 2026 📋 Checked against the OASIS-E2 manual

The Short Answer

M1800-M1860 record the patient's ability to perform seven ADLs safely on the day of assessment, coded by the level of help another person must give. The items appear at Start of Care, Resumption of Care, Follow-up, and Discharge. Score ability, not willingness. When ability varies, code what is true more than 50% of the time. Together with M1033, these items earn the points behind the PDGM functional impairment level.

Part of the OASIS-E2 Item Guide. Every rule below comes from the CMS OASIS-E2 Guidance Manual (effective April 1, 2026), Chapter 1 conventions and Chapter 3 Section G. The manual is the binding source. This page paraphrases it.

The Seven Items at a Glance

All seven items are completed at SOC, ROC, Follow-up, and Discharge. A dash is not a valid response for any of them. Appendix B of the manual lists each one as a PDGM payment item.

Item	What it measures	Responses
M1800 Grooming	Face and hand washing, hair care, shaving or makeup, teeth or denture care, fingernail care	0-3
M1810 Dress Upper Body	Getting, putting on, and removing upper body clothing, including zippers, buttons, and snaps	0-3
M1820 Dress Lower Body	Undergarments, slacks, socks or nylons, and shoes	0-3
M1830 Bathing	Washing the entire body, including getting in and out of the tub or shower	0-6
M1840 Toilet Transferring	Getting to and from the toilet or commode and on and off it	0-4
M1850 Transferring	Bed to chair and back, or turning and positioning if bedfast	0-5
M1860 Ambulation/Locomotion	Walking, or wheeling once seated, over the surfaces the patient routinely meets	0-6

M1845 Toileting Hygiene sits in the same section but is collected at SOC, ROC, and Discharge only, and it does not feed PDGM.

Rules for Every ADL Item

Ability, not willingness. Report the physical and cognitive ability to do the task safely. Preference, willingness, and adherence are not the focus.
Assistance means another person. Verbal cues, reminders, supervision, stand-by help, and hands-on help all count.
Day of assessment. The look-back is the 24 hours before the visit plus the time the clinician spends in the home.
The 50% rule. If ability varies, code what is true more than 50% of the time under consideration.
Multi-task items. When ability differs across tasks, code the majority of tasks and weight the ones done most often.
Medical restrictions count. Ordered activity limits shape the best response for ambulation, transfers, and bathing.
Caregivers do not change the code. Their presence or absence affects how a task gets done, not the level of help the patient needs.
Observe first. Observation and demonstration are preferred. Interview and input from other agency staff support it.

Item-by-Item Scoring Notes

M1800 Grooming

Bathing, shampooing hair, and toileting hygiene are excluded. Response 0 means the patient grooms unaided, with or without devices. Response 1 means grooming utensils must be placed within reach first. Response 2 means someone must assist. Response 3 means the patient depends entirely on someone else. A patient who washes hands and face but cannot trim nails has more ability, because the manual weights frequent tasks higher.

M1810 and M1820 Dressing

Both use a 0-3 scale. Response 0: gets clothes out and dresses without help. Response 1: dresses without help if clothes are laid out or handed over. Response 2: someone must help put clothing on. Response 3: depends entirely on another person. Score the clothing the patient routinely wears. Modified clothing becomes routine when the patient is not expected to return to the old style.

An arm sling, cervical collar, or upper limb prosthesis counts as upper body dressing.
A lower limb prosthesis, ankle-foot orthosis, or anti-embolism stockings count as lower body dressing.
Reserve response 3 for a patient who relies on another person for the majority of the dressing tasks. A patient who participates but needs help is a 2.

M1830 Bathing

Washing the face and hands and shampooing are excluded. Responses 0-3 describe bathing in the tub or shower: independent (0), independent with devices (1), intermittent help for supervision, transfers, or hard-to-reach areas (2), and another person present throughout (3). Responses 4-6 apply when the patient cannot use the tub or shower: bathes independently at the sink, in a chair, or on a commode (4), participates with help outside the tub or shower (5), or is bathed totally by another person (6).

Use 4, 5, or 6 when the patient has no tub or shower, the tub or shower is broken or unsafe, or a stair restriction blocks access to it. Do not code ability based on equipment the patient has not been assessed using.

M1840 Toilet Transferring

Hygiene and clothing management are excluded. Response 0 is independent. Response 1 covers reminders, stand-by help, or supervision to reach the toilet or to transfer. Response 2 means the patient cannot reach the toilet but uses a bedside commode. Response 3 means the patient uses a bedpan or urinal independently. Response 4 is totally dependent. A patient who walks to the toilet by day and uses a commode at night for convenience is a 0. New in E2: incontinence on the way to the toilet matters only if it affects the patient's ability to get there and transfer safely.

M1850 Transferring

The scale runs from 0 (independent) to 5 (bedfast and unable to turn or position self). The line between 1 and 2 causes the most disagreement:

Code 1: minimal human help with no device, or a device with no human help.
Code 2: minimal human help plus a device, or more than minimal help for a patient who bears weight and pivots.
Code 3: the patient cannot bear weight or pivot and is not bedfast.

Minimal human assistance means the helper supplies less than 25% of the effort. Bearing weight means supporting most of the body weight through any combination of limbs. Bedfast means confined to bed by order or by intolerance of being up.

M1860 Ambulation/Locomotion

Responses 0-3 cover walking: no device or help (0), a one-handed device such as a cane (1), a two-handed device such as a walker, or help on stairs and uneven surfaces (2), and supervision or help at all times (3). Responses 4 and 5 are chairfast, able or unable to wheel self. Response 6 is bedfast. Any human help points to 2 or 3, with or without a device. Intermittent help is a 2. Continuous help is a 3. A patient who takes one or two steps only to complete a transfer is chairfast for this item.

Common Scoring Errors

Coding what the patient chooses to do. A patient who prefers help with dressing but dresses safely alone is still a 0.
Coding caregiver availability. The code reflects the help the patient needs, whether or not anyone is there to give it.
Copying the hospital record. Functional status comes from your agency's assessment, not from a prior setting's documentation.
Mixing up M1850 codes 1 and 2. Check both the device and the share of effort the helper supplies.
Missing intermittent vs continuous help in M1860. The difference moves the code from 2 to 3.
Counting excluded tasks. Hygiene and clothing belong to M1845, not M1840. Shampooing belongs to neither M1800 nor M1830.
Narrative conflicts. A note describing a walker and contact guard does not support M1860 response 0.

How These Items Feed the PDGM Functional Level

The CY 2026 Home Health PPS final rule confirms the method:

Each response to M1800-M1860 and M1033 Risk for Hospitalization earns points. Higher points reflect higher expected resource use.
CMS sums the points into a functional impairment score.
The score places the 30-day period in a low, medium, or high level. Thresholds differ by clinical group, set so roughly one-third of periods in each group land in each level.
CMS recalibrates the points and thresholds every year. The CY 2026 tables use CY 2024 claims data.

CMS uses the start of care OASIS for this score, and the follow-up OASIS completed near recertification for the third and fourth 30-day periods. CMS does not use the discharge OASIS for payment. Section GG items and M2020 earn no PDGM functional points, and Appendix B of the manual does not list M1845 as a payment item. The level is one of five PDGM case-mix variables, alongside the clinical group from the principal diagnosis, comorbidities, admission source, and timing. See the PDGM overview for the full model.

Point values change each January, so take them from the current final rule, not from an old cheat sheet.

How M1800-M1860 Relate to Section GG

OASIS-E2 measures function twice. The M18xx items use item-specific scales and drive payment. GG0130 and GG0170 use a 6-point scale shared with other post-acute settings and feed quality measures and HHVBP. The task definitions differ, so the codes will not line up one to one:

M1830 Bathing includes tub and shower transfers. GG0130E Shower/bathe self excludes them and excludes washing the back and hair.
M1840 includes getting to and from the toilet. GG0170F Toilet transfer covers only getting on and off.
M1820 includes shoes. GG0130G Lower body dressing excludes footwear, which GG0130H scores on its own.

The two sets should still describe the same patient on the same visit. A patient coded independent in M1860 and dependent for GG0170I Walk 10 feet needs a second look before submission.

Where Documentation Goes Wrong

Most ADL errors start with a gap between what the clinician saw and what the form says. Lime's OASIS Scribe drafts M1800-M1860 responses from the visit conversation and flags conflicts, such as a walker in the narrative next to an M1860 of 0, so your QA team corrects them before submission. The assessing clinician reviews and confirms every final response, as CMS requires.

CMS Sources

OASIS-E2 Guidance Manual (PDF): Chapter 1 ADL conventions, Chapter 3 Section G, Appendix B uses, Appendix D changes.
CMS OASIS User Manuals page, home of the manual and the OASIS Q&As.
CY 2026 Home Health PPS final rule: functional points and impairment levels.

Related Item Guides

FAQ

M1800-M1860, Answered

The questions coders and clinicians search for on the OASIS ADL items.

Score the patient's ability to wash face and hands, care for hair, shave or apply makeup, clean teeth or dentures, and care for fingernails. Bathing, shampooing, and toileting hygiene are excluded. Response 0 means the patient grooms unaided, 1 means utensils must be placed within reach first, 2 means someone must assist, and 3 means the patient depends entirely on someone else. When ability differs across tasks, code the majority of tasks and give more weight to tasks performed more often, such as washing hands and face.

Code 1 when the patient transfers with minimal human assistance but no device, or with a device but no human assistance. Code 2 when the patient needs both minimal human assistance and a device, or bears weight and pivots but needs more than minimal human assistance. The OASIS-E2 manual defines minimal human assistance as a helper contributing less than 25% of the total effort.

Ability. The OASIS-E2 manual says these items report what the patient is able to do safely, not willingness, preference, or adherence. Code the level of assistance the patient needs on the day of assessment. Caregiver presence or absence does not change the code.

M1800, M1810, M1820, M1830, M1840, M1850, M1860, and M1033 Risk for Hospitalization. Each response earns points, CMS sums the points, and the total places the 30-day period in a low, medium, or high level using thresholds set for each clinical group. Section GG items and M2020 are not part of the PDGM functional score.

Yes. All seven items appear in the OASIS-E2 item set effective April 1, 2026, at Start of Care, Resumption of Care, Follow-up, and Discharge. CMS did not change their response options for E2. The only new guidance in this group is an M1840 coding tip on incontinence on the way to the toilet.

Not code for code. The M items and GG items use different scales, different task definitions, and serve different purposes. M1830 Bathing includes getting in and out of the tub, while GG0130E Shower/bathe self excludes the transfer. The two sets should describe the same patient, though. Large conflicts, such as independent ambulation in M1860 with dependent walking in GG0170, deserve a QA review.

Draft OASIS ADL responses from the visit conversation.

See OASIS Scribe