CMO Case Classifier
Identify what type of CMO documentation is in your chart, then resolve whether it satisfies the denominator exclusion.
How to useSelect every documentation type present in the chart. The tool evaluates whether any combination meets the specification. Multiple selections are allowed — check all that apply, then hit Evaluate.
Step 1 — What documentation is present?
Physician Order
Explicit CMO order by MD/APN/PA in the order set or written orders
Physician Note — Discussion
Progress note or H&P documenting a goals-of-care discussion with CMO decision
POLST / MOST / MOLST
Portable medical order form signed by physician
Hospice Enrollment/Referral
Documentation of hospice referral, enrollment, or transfer during this admission
Comfort Care Orders Only
Symptom management orders (pain, positioning, mouth care) without a CMO designation
Family/Care Conference Note
Nursing or social work note documenting family meeting; no physician co-sign
DNR/DNI Order Only
Do-not-resuscitate or do-not-intubate order without explicit CMO language
Palliative Care Consult
Palliative care team note documenting CMO recommendation or plan
Step 2 — Timing Flags
Exclusion Result
CMO Exclusion
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Basis
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Guided Workflow
Answer each question to determine CMO exclusion eligibility step by step.
Step 1 — Document Type
Is there a physician, APN, or PA order or documented discussion designating the patient as Comfort Measures Only?
This is the threshold questionThe source must come from a licensed independent practitioner — MD, DO, APN, or PA. Nursing notes, social work notes, or family conference documentation alone do not qualify without an LIP co-signature or a corresponding physician order.
Quick Reference
v2026A · CMO Denominator Exclusion — STK-6 / ASR-IP
Documentation Eligibility Matrix
Not all comfort-related documentation is equal. This matrix shows what qualifies, what does not, and what requires additional scrutiny before counting.
| Documentation Type | Qualifies? | Key Condition / Caveat |
|---|---|---|
| Physician/APN/PA explicit CMO order | ✓ Yes | Strongest basis. Confirm order was not subsequently rescinded. |
| Physician progress note — CMO discussion | ✓ Yes | Must document the decision, not just that a conversation occurred. "Discussed goals of care" alone is insufficient. |
| POLST — Comfort-Focused Treatment checked | ✓ Yes | POLST is a physician order. Verify the correct section is completed and signed. |
| POLST — Full Treatment or Limited checked | ✗ No | POLST is present but does not indicate CMO. Section checked matters, not just presence of form. |
| Hospice enrollment during admission | ⚠ Review | Hospice referral ≠ automatic CMO. Verify accompanying physician order or note explicitly designating CMO. |
| Palliative care consult note — CMO plan | ⚠ Review | Palliative consult recommending CMO is not sufficient alone. Requires attending order or documentation adopting the plan. |
| DNR/DNI order without CMO language | ✗ No | DNR ≠ CMO. Resuscitation limitation is not the same as comfort-focused care designation. |
| Nursing/social work comfort care note | ✗ No | Non-LIP documentation does not satisfy the exclusion alone. Nursing "comfort care" charting is not a CMO order. |
| Symptom management orders only | ✗ No | "Comfort care measures" (pain meds, positioning, mouth care) ordered without CMO designation do not qualify. |
| Family meeting note — comfort decision | ✗ No | Family agreement documented without an LIP order or co-signed note does not satisfy the exclusion. |
Counts as CMO
Explicit physician CMO order✓ Yes
MD note documenting CMO decision✓ Yes
POLST — comfort-focused section checked✓ Yes
Hospice + explicit CMO order✓ Yes
Attending adopts palliative CMO plan✓ Yes
Does NOT Count as CMO
DNR/DNI only✗ No
Nursing comfort care charting alone✗ No
Symptom management orders only✗ No
POLST — full/limited treatment checked✗ No
Family meeting note without LIP order✗ No
Hospice referral without CMO order✗ No
Palliative consult without attending adoption✗ No
Timing Rules
Must be established during admissionBefore death/discharge
After brain death onlyDoes NOT count
Pre-hospital POLST, not reaffirmed⚠ Review
CMO then rescindedDoes NOT count
CMO established, death followsCounts
POLST Checklist
Is the form signed by a physician?Required
Which section is checked?Must verify
"Comfort-Focused" or equivalent?✓ Qualifies
"Full Treatment" checked?✗ No
"Limited Interventions" checked?✗ No
Was it enacted this admission?Confirm
Top Abstractor Pitfalls
Pitfall #1 — Comfort care orders ≠ CMO"Comfort care measures" ordered (morphine drip, repositioning q2h, oral care) does not equal a CMO designation. The presence of symptom-focused orders without an explicit CMO plan does not satisfy the exclusion.
Pitfall #2 — DNR is not CMOA DNR or DNI order limits resuscitation — it does not establish a comfort-only care plan. A patient can have a full DNR and still be receiving aggressive curative treatment. Never equate code status with CMO.
Pitfall #3 — Discussion ≠ DecisionA physician note that says "discussed goals of care with family" without documenting the outcome of that discussion does not satisfy the exclusion. The note must reflect that CMO was decided upon as the plan.
Pitfall #4 — POLST section checkA POLST in the chart does not automatically equal CMO. You must look at which section is checked. "Full Treatment" and "Limited Interventions" do not qualify. Only "Comfort-Focused Treatment" (or state equivalent) satisfies the exclusion.
Pitfall #5 — Hospice referral without accompanying orderHospice referral or enrollment documentation suggests CMO intent but is not sufficient alone. Always look for an accompanying physician order or note explicitly establishing CMO. Hospice can overlap with non-CMO designations in some edge cases.
Pitfall #6 — Palliative care consult without attending adoptionA palliative care team can recommend CMO, but that recommendation does not bind the plan of care. The attending of record must document adoption of the CMO plan, or issue a corresponding order.
Pitfall #7 — Pre-hospital POLST not reaffirmedA POLST from a prior admission or outpatient setting may be in the chart. Verify whether it was acknowledged, reaffirmed, or updated during this admission. A stale POLST that was not reviewed by the treating team during this encounter is questionable.
Pitfall #8 — Post-brain death CMO onlyCMO documented solely after a formal brain death declaration does not satisfy the exclusion. The CMO plan must have been established as the care plan for this living patient during the admission — not as a documentation step after brain death is pronounced.
Practice Quiz
10 scenario-based questions covering CMO documentation, POLST interpretation, timing rules, and common pitfalls.
Case Walkthroughs
Step-by-step cases that walk through CMO abstraction reasoning at every decision point.
How to useSelect a case, then work through each step. The trainer's reasoning appears at each decision point — including why certain documentation counts or does not count.