-3009
| Property | Specification |
| Data System | HOPE |
| Data Specs | V1.00.0 |
| Edit Type | Format |
| Severity | Fatal |
| Edit Text |
Values of Code and Checklist Items: Only the coded values listed in the "Item Values" table of the Detailed Data Specifications Report may be submitted for this item. |
| Version Notes |
| Item List | |
| Item ID | Description |
| ITM_SET_SYS_CD | Item set system code |
| ITM_SBST_CD | Item subset code |
| STATE_CD | Provider"s state postal code |
| A0050 | Type of record |
| A0215 | Site of service at admission |
| A0250 | Reason for record |
| A0800 | Gender |
| A1005A | Ethnicity: No, not Hispanic, Latino/a, Spanish |
| A1005B | Ethnicity: Yes, Mex, Mex Amer, Chicano/a |
| A1005C | Ethnicity: Yes, Puerto Rican |
| A1005D | Ethnicity: Yes, Cuban |
| A1005E | Ethnicity: Yes, another Hispanic/Latino/Spanish |
| A1005X | Ethnicity: Patient unable to respond |
| A1005Y | Ethnicity: Patient declines to respond |
| A1010A | Race: White |
| A1010B | Race: Black or African American |
| A1010C | Race: American Indian or Alaska Native |
| A1010D | Race: Asian Indian |
| A1010E | Race: Chinese |
| A1010F | Race: Filipino |
| A1010G | Race: Japanese |
| A1010H | Race: Korean |
| A1010I | Race: Vietnamese |
| A1010J | Race: Other Asian |
| A1010K | Race: Native Hawaiian |
| A1010L | Race: Guamanian or Chamorro |
| A1010M | Race: Samoan |
| A1010N | Race: Other Pacific Islander |
| A1010X | Race: Patient unable to respond |
| A1010Y | Race: Patient declines to respond |
| A1010Z | Race: None of the above |
| A1110B | Does the patient need or want an interpreter |
| A1400A | Payer: Medicare (FFS) |
| A1400B | Payer: Medicare (managed care/Part C/Mcr Advant.) |
| A1400C | Payer: Medicaid (FFS) |
| A1400D | Payer: Medicaid (managed care) |
| A1400G | Payer: Other Government |
| A1400H | Payer: Private insurance/Medigap |
| A1400I | Payer: Private managed care |
| A1400J | Payer: Self-pay |
| A1400K | Payer: No payor source |
| A1400X | Payer: Unknown |
| A1400Y | Payer: Other |
| A1805 | Admitted from |
| A1905 | Living Arrangements |
| A1910 | Availability of Assistance |
| A2115 | Reason for discharge |
| F2000A | Was ptnt/rsp prty asked about CPR |
| F2100A | Was ptnt/rsp prty asked treatments oth than CPR |
| F2200A | Was ptnt/rsp prty asked hospitalization |
| F3000A | Was ptnt/crgvr asked sprtual/exstntial cncrns |
| I0010 | Principal diagnosis |
| I0100 | Cancer |
| I0600 | Heart Failure |
| I0900 | Peripheral Disease (PVD or PAD) |
| I0950 | Cardiovascular (excluding heart failure) |
| I1101 | Liver disease (e.g., cirrhosis) |
| I6202 | Chronic Obstructive Pulmonary Disease (COPD) |
| I2102 | Sepsis |
| I2900 | Diabetes Mellitus (DM) |
| I2910 | Neuropathy |
| I4501 | Stroke |
| I4801 | Dementia (including Alzheimer’s disease) |
| I5150 | Neurological Conditions |
| I5401 | Seizure Disorder |
| I1510 | Renal disease |
| I8005 | Other Medical Condition |
| J0050 | Death is Imminent |
| J0900A | Was patient screened for pain |
| J0900C | Patient"s pain severity was |
| J0900D | Type of standardized pain tool used |
| J0905 | Is pain an active problem for the patient? |
| J0910A | Was comprehensive pain assessment done |
| J0910C1 | Pain asmt included: location |
| J0910C2 | Pain asmt included: severity |
| J0910C3 | Pain asmt included: character |
| J0910C4 | Pain asmt included: duration |
| J0910C5 | Pain asmt included: frequency |
| J0910C6 | Pain asmt included: what relieves/worsens |
| J0910C7 | Pain asmt included: effect function/quality life |
| J0910C9 | Pain asmt included: none of the above |
| J0915 | Neuropathic Pain |
| J2030A | Was patient screened for shortness of breath |
| J2030C | Did screening indicate pt had shortness of breath |
| J2040A | Was treatment for shortness of breath initiated |
| J2050A | Was symptom impact screening completed |
| J2051A | Symptom Impact - Pain |
| J2051B | Symptom Impact - Shortness of breath |
| J2051C | Symptom Impact - Anxiety |
| J2051D | Symptom Impact - Nausea |
| J2051E | Symptom Impact - Vomiting |
| J2051F | Symptom Impact - Diarrhea |
| J2051G | Symptom Impact - Constipation |
| J2051H | Symptom Impact - Agitation |
| J2052A | Was in-person SFV completed |
| J2052B | Date of in-person SFV |
| J2052C | Reason SFV Not Completed |
| J2053A | SFV Symptom Impact Since Screen - Pain |
| J2053B | SFV Symptom Impact Since Screen - Shortness breath |
| J2053C | SFV Symptom Impact Since Screen - Anxiety |
| J2053D | SFV Symptom Impact Since Screen - Nausea |
| J2053E | SFV Symptom Impact Since Screen - Vomiting |
| J2053F | SFV Symptom Impact Since Screen - Diarrhea |
| J2053G | SFV Symptom Impact Since Screen - Constipation |
| J2053H | SFV Symptom Impact Since Screen - Agitation |
| M1190 | Patient has one or more skin conditions |
| M1195A | Skin Condition - Diabetic foot ulcer(s) |
| M1195B | Skin Condition - Open lesion(s) |
| M1195C | Skin Condition - Pressure Ulcer(s)/Injuries |
| M1195D | Skin Condition - Rash(es) |
| M1195E | Skin Condition - Skin tear(s) |
| M1195F | Skin Condition - Surgical wound(s) |
| M1195G | Skin Condition - Ulcers (not diabetic or pressure) |
| M1195H | Skin Condition - Moisture Associated Skin Damage |
| M1195Z | Skin Condition - None of the above |
| M1200A | Treatments - Pressure reducing device for chair |
| M1200B | Treatments - Pressure reducing device for bed |
| M1200C | Treatments - Turning/repositioning program |
| M1200D | Treatments - Nutrition or hydration intervention |
| M1200E | Treatments - Pressure ulcer/injury care |
| M1200F | Treatments - Surgical wound care |
| M1200G | Treatments - Apply nonsurgical dressings-not feet |
| M1200H | Treatments - Apply ointments/meds (not feet) |
| M1200I | Treatments - Application of dressings to feet |
| M1200J | Treatments - Incontinence Management |
| M1200Z | Treatments - None of the above |
| N0500A | Was scheduled opioid initiated or continued |
| N0510A | Was PRN opioid initiated or continued |
| N0520A | Was bowel regimen initiated or continued |
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Generated: 09/30/2024 02:43:05 PM