Appendix C. Mapping of CMS-485 and e-485 to the Continuity of Care Record

Development of Electronic Transition Tools for Home Health Care

	CMS-485	e-485 (extended version of CMS-485)	CCR (Continuity of Care Record)
1	Patient HI Claim No.	Patient HI Claim No.
2	Start of Care Date	Start of Care Date	<PlanOfCare><Plan><DateTime>
3	Certification Period	Certification Period	<PlanOfCare><Plan><DateTime>**
4	Medical Record No.	Omitted	Omitted
5	Provider No.	Omitted	Omitted
6	Patient Information	Patient Information	<Actor>
7	Provider Information	Provider Information	<Actor>
8	Date of Birth	Date of Birth	<Actor>
9	Sex	Sex	<Actor>
10	Medications	Medications	<PlanOfCare><Plan><OrderRequest>
		Medication Adjustment	<PlanOfCare><Plan><OrderRequest>
		Physician Notification	<PlanOfCare><Plan><OrderRequest>
11	Principal Diagnosis	Principal Diagnosis	<Body><Problems>
11	Other Diagnosis	Other Diagnosis	<Body><Problems>
12	Surgical Procedure, date, ICD-9 code	Surgical Procedure, date, ICD-9 code	<Body><Problems>
13	Other Pertinent Diagnosis: date of onset/exacerbation	Other Pertinent Diagnosis: date of onset/exacerbation	<Body><Problems>
14	DME and Supplies	DME and Supplies	<PlanOfCare><Plan><OrderRequest>
15	Safety Measures	Safety Measures	<PlanOfCare><Plan><OrderRequest>
16	Nutritional Requirements	Nutritional Requirements	<PlanOfCare><Plan><OrderRequest>
17	Allergies	Allergies	<Body><Alerts>
18A	Functional Limitations	Functional Limitations	<Body><Problems>
18B	Activities Permitted	Activities Permitted	<PlanOfCare><Plan><OrderRequest>
19	Mental Status	Mental Status	<Body><FunctionalStatus>
20	Prognosis	Prognosis	<Body><Problems>
21	Orders for Discipline and Treatments	Orders for Discipline and Treatments	<PlanOfCare><Plan><OrderRequest>
22	Goals	Goals/Rehab	<PlanOfCare><Plan><DischargePlan>
22	Discharge Plan	Discharge Plan	<PlanOfCare><Plan><DischargePlan>
22	Rehab Potential	Rehab Potential	<PlanOfCare><Plan><DischargePlan>

Notes:
Since the e-485 was for start of home care, the start of the certification period = the start of the care date.
It is not clear from the CCR documentation where to put financial certification information.

Page last reviewed September 2007

Internet Citation: Appendix C. Mapping of CMS-485 and e-485 to the Continuity of Care Record: Development of Electronic Transition Tools for Home Health Care. September 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/etransitions/etransitionsapc.html