-3009
| Property | Specification |
| Data System | Hospice |
| Data Specs | V3.00.0 |
| 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 | [V3.00.0]-Removed mappings to O5000 and O5020, since those items were deleted. |
| 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 |
| A0205 | Site of service at admission |
| A0250 | Reason for record |
| A0800 | Gender |
| A1000A | Ethnicity: American Indian or Alaska Native |
| A1000B | Ethnicity: Asian |
| A1000C | Ethnicity: Black or African American |
| A1000D | Ethnicity: Hispanic or Latino |
| A1000E | Ethnicity: Native Hawaiian/Pacific Islander |
| A1000F | Ethnicity: White |
| A1400A | Payor: Medicare (FFS) |
| A1400B | Payor: Medicare (managed care/Part C/Mcr Advant.) |
| A1400C | Payor: Medicaid (FFS) |
| A1400D | Payor: Medicaid (managed care) |
| A1400G | Payor: Other Government |
| A1400H | Payor: Private insurance/Medigap |
| A1400I | Payor: Private managed care |
| A1400J | Payor: Self-pay |
| A1400K | Payor: No payor source |
| A1400X | Payor: Unknown |
| A1400Y | Payor: Other |
| A1802 | Admitted from |
| A2115 | Reason for discharge |
| F2000A | Was patient asked about CPR |
| F2100A | Was patient asked about treatments other than CPR |
| F2200A | Was patient asked about hospitalization |
| F3000A | Was patient asked spiritual/existential concerns |
| I0010 | Principal diagnosis |
| 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 |
| 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 |
| J2040C1 | Type(s) treat for shortness of breath: opioids |
| J2040C2 | Type(s) treat for shortness of breath: other med |
| J2040C3 | Type(s) treat for shortness of breath: oxygen |
| J2040C4 | Type(s) treat for shortness of breath: non-med |
| 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: 08/06/2020 09:24:06 AM