Coding Crosswalks between the MDS version 2.0 and HCFA 672 and 802 Forms

For the 802 and QI purposes 276.50, 276.51, and 276.52 as well as 276.5 should be treated as though they are Dehydration.

See Downloads below for an explanation of the following HCFA forms as they apply to the MDS 2.0.

  • HCFA 672 instructions, including crosswalk to MDS 2.0 10/98
  • HCFA 802 Provider Instructions - Vendor Programming Crosswalk Instructions 12/99

For Survey and 802 form related questions see Frequently Asked Questions (see Related Links Inside CMS below).

Facility Automation of the MDS Crosswalks to the 672 and 802 Forms (9/25/2001):

Information included on the 672 and 802 forms is limited to residents on Medicare and/or Medicaid certified units. Therefore, MDS information crosswalked to the 672 and 802 Forms is also limited to MDS assessments performed for residents while on a certified unit. The SUB_REQ field being implemented on 11/26/2001, for MDS records submitted by the facility to the state, will allow selection of the appropriate certified-unit MDS assessments. SUB_REQ has a value of 3 for certified units and a value of 1 or 2 for non-certified units. MDS crosswalks to the 672 and 802 Forms must be limited to MDS assessments with SUB_REQ = 3. See data specifications for the SUB_REQ field in Downloads below.

Long-Term Care Survey Process Forms

HCFA Forms 801, 803, 804, 805, 806, and 807 are also available in our CMS Forms section of the website (see Related Links Inside CMS below).


Page Last Modified:
12/01/2021 07:02 PM