-1009
| Property | Specification |
| Data System | LTCH |
| Data Specs | V4.00.0 DRAFT |
| Edit Type | Format |
| Severity | Fatal |
| Edit Text | Only the code values listed in the "Item Values" table of the Detailed Data Specifications Report may be submitted for this item. |
| Version Notes | [V4.00.0] - Removing references to the following fields as these fields deleted: A1000A, A1000B, A1000C, A1000D, A1000E, A1000F, A1100A, A1802, A2110, C1610A, C1610B, C1610C, C1610D, C1610E1, C1610E2, O0100G, O0100H, O0100H2A, O0100J, O0100N, O0100Z. Adding references to newly added fields: A1005A-X, A1010A-X, A1110B, A1805, A2105, A1990, A1250A-X, A2121, A2122, A2123, A2124, B0200, B1000, B1300, C0100, C0200, C0300A, C0300B, C0300C, C0400A, C0400B, C0400C, C0500, C1310A, C1310B, C1310C, C1310D, D0150A1, D0150A2, D0150B1, D0150B2, D0150C1, D0150C2, D0150D1, D0150D2, D0150E1, D0150E2, C0150F1, D0150F2, D0150G1, D0150G2, D0150H1, D0150H2, D0150I1, D0150I2, D0160, D0700, J0510, J0520, J0530, K0520A1, K0520A4, K0520A5, K0520B1, K0520B4, K0520B5, K0520C1, K0520C4, K0520C5, K0520D1, K0520D4, K0520D5, K0520Z1, K0520Z4, K0520Z5, N0415A1, N0415A2, N0415E1, N0415E2, N0415F1, N0415F2, N0415H1, N0415H2, N0415I1, N0415I2, N0415J1, N0415J2, N0415Z1, N0415Z2, O0110A1a, O0110A2a, O0110A3a, O0110A10a, O0110B1a, O0110A1c, O0110A2c, O0110A3c, O0110A10c, O0110B1c, O0110C1a, O0110C2a, O0110C3a, O0110C4a, O0110D1a. O0110D2a, O0110D3a, O0110E1a, O0110G1a, O0110G2a, O0110G3a, O0110C1c, O0110C2c, O0110C3c, O0110C4c, O0110D1c, O0110D2c, O0110D3c, O0110E1c, O0110F1c, O0110G1c, O0110G2c, O0110G3c, O0110H1c, O0110H2c, O0110H3c, O0110H4c, O0110H10c, O0110I1c, O0110J1c, O0110J2c, O0110J3c, O0110Z1c, A1990 |
| Item List | |
| Item ID | Description |
| ASMT_SYS_CD | Assessment system code |
| ITM_SBST_CD | Item subset code |
| STATE_CD | Facility"s state postal code |
| A0050 | Type of record |
| A0200 | Type of provider |
| A0250 | Reason for Assessment |
| A0800 | Gender |
| A1005A | No, not of Hispanic, Latino/a, or Spanish origin |
| A1005B | Yes, Mexican, Mexican American, Chicano/ |
| A1005C | Yes, Puerto Rican |
| A1005D | Yes, Cuban |
| A1005E | Yes, another Hispanic, Latino, or Spanish origin |
| A1005X | Patient unable 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 |
| A1110B | Do you need or want an interpreter |
| A1200 | Marital status |
| A1250A | Transportation: Yes, medical |
| A1250B | Transportation: Yes, non-medical |
| A1250C | Transportation: No |
| A1250X | Transportation: Patient unable to respond |
| A1400A | Payer: Medicare (FFS) |
| A1400B | Payer: Medicare (managed care/Part C/Mcr Advant.) |
| A1400C | Payer: Medicaid (FFS) |
| A1400D | Payer: Medicaid (managed care) |
| A1400E | Payer: Workers" compensation |
| A1400F | Payer: Title programs |
| A1400G | Payer: Other Government |
| A1400H | Payer: Private insurance/Medigap |
| A1400I | Payer: Private managed care |
| A1400J | Payer: Self-pay |
| A1400K | Payer: No payer source |
| A1400X | Payer: Unknown |
| A1400Y | Payer: Other |
| A1805 | Admitted from |
| A1990 | Discharged against medical advice |
| A2105 | Discharge location |
| A2121 | Provision Current Reconciled Medication List |
| A2122A | Electronic Health Record |
| A2122B | Health Information Exchange Organization |
| A2122C | Verbal |
| A2122D | Paper-based |
| A2122E | Other Methods |
| A2123 | Provision Current Reconciled Medication |
| A2124A | Electronic Health Record |
| A2124B | Health Information Exchange Organization |
| A2124C | Verbal |
| A2124D | Paper-based |
| A2124E | Other Methods |
| B0100 | Comatose |
| B0200 | Hearing |
| B1000 | Vision |
| B1300 | Health Literacy |
| BB0700 | Expression of Ideas and Wants (3-day asmt period) |
| BB0800 | Understand Verbal/Non-Verbal Content (3-day asmt) |
| C0100 | Brief Interview for Mental Status |
| C0200 | Repetition of three words |
| C0300A | Able to report correct year |
| C0300B | Able to report correct month |
| C0300C | Able to report correct day of the week |
| C0400A | Able to recall "sock" |
| C0400B | Able to recall "blue" |
| C0400C | Able to recall "bed" |
| C0500 | BIMS Summary Score |
| C1310A | Acute Onset Mental Status Change |
| C1310B | Inattention |
| C1310C | Disorganized thinking |
| C1310D | Altered level of consciousness |
| D0150A1 | Little interest or pleasure in doing things: Pres |
| D0150A2 | Little interest or pleasure in doing things: Freq |
| D0150B1 | Feeling down, depressed, or hopeless: Pres |
| D0150B2 | Feeling down, depressed, or hopeless: Freq |
| D0150C1 | Trouble falling or staying asleep: Pres |
| D0150C2 | Trouble falling or staying asleep: Freq |
| D0150D1 | Feeling tired or having little energy: Pres |
| D0150D2 | Feeling tired or having little energy: Freq |
| D0150E1 | Poor appetite or overeating: Pres |
| D0150E2 | Poor appetite or overeating: Freq |
| D0150F1 | Feeling bad about yourself: Pres |
| D0150F2 | Feeling bad about yourself: Freq |
| D0150G1 | Trouble concentrating on things: Pres |
| D0150G2 | Trouble concentrating on things: Freq |
| D0150H1 | Moving or speaking so slowly: Pres |
| D0150H2 | Moving or speaking so slowly: Freq |
| D0150I1 | Thoughts that you would be better off dead: Pres |
| D0150I2 | Thoughts that you would be better off dead: Freq |
| D0160 | Total severity score |
| D0700 | Social Isolation |
| GG0100B | Indoor Mobility (Ambulation) |
| GG0110A | Manual wheelchair |
| GG0110B | Motorized wheelchair and/or scooter |
| GG0110C | Mechanical lift |
| GG0110Z | None of the above |
| GG0130A1 | Self-Care (Adm Perf) - Eating |
| GG0130A2 | Self-Care (Dschg Goal) - Eating |
| GG0130A3 | Self-Care (Dschg Perf) - Eating |
| GG0130B1 | Self-Care (Adm Perf) - Oral hygiene |
| GG0130B2 | Self-Care (Dschg Goal) - Oral hygiene |
| GG0130B3 | Self-Care (Dschg Perf) - Oral hygiene |
| GG0130C1 | Self-Care (Adm Perf) - Toileting hygiene |
| GG0130C2 | Self-Care (Dschg Goal) - Toileting hygiene |
| GG0130C3 | Self-Care (Dschg Perf) - Toileting hygiene |
| GG0130D1 | Self-Care (Adm Perf) - Wash upper body |
| GG0130D2 | Self-Care (Dschg Goal) - Wash upper body |
| GG0130D3 | Self-Care (Dschg Perf) - Wash upper body |
| GG0170A1 | Func Mobil (Adm Perf) - Roll left and right |
| GG0170A2 | Func Mobil (Dschg Goal) - Roll left and right |
| GG0170A3 | Func Mobil (Dschg Perf) - Roll left and right |
| GG0170B1 | Func Mobil (Adm Perf) - Sit to lying |
| GG0170B2 | Func Mobil (Dschg Goal) - Sit to lying |
| GG0170B3 | Func Mobil (Dschg Perf) - Sit to lying |
| GG0170C1 | Func Mobil (Adm Perf) - Lying to sitting on side |
| GG0170C2 | Func Mobil (Dschg Goal) - Lying to sitting on side |
| GG0170C3 | Func Mobil (Dschg Perf) - Lying to sitting on side |
| GG0170D1 | Func Mobil (Adm Perf) - Sit to stand |
| GG0170D2 | Func Mobil (Dschg Goal) - Sit to stand |
| GG0170D3 | Func Mobil (Dschg Perf) - Sit to stand |
| GG0170E1 | Func Mobil (Adm Perf) - Chair/bed-to-chair trans |
| GG0170E2 | Func Mobil (Dschg Goal) - Chair/bed-to-chair trans |
| GG0170E3 | Func Mobil (Dschg Perf) - Chair/bed-to-chair trans |
| GG0170F1 | Func Mobil (Adm Perf) - Toilet transfer |
| GG0170F2 | Func Mobil (Dschg Goal) - Toilet transfer |
| GG0170F3 | Func Mobil (Dschg Perf) - Toilet transfer |
| GG0170I1 | Func Mobil (Adm Perf) - Walk 10 feet |
| GG0170I2 | Func Mobil (Dschg Goal) - Walk 10 feet |
| GG0170I3 | Func Mobil (Dschg Perf) - Walk 10 feet |
| GG0170J1 | Func Mobil (Adm Perf) - Walk 50 feet w/2 turns |
| GG0170J2 | Func Mobil (Dschg Goal) - Walk 50 feet w/2 turns |
| GG0170J3 | Func Mobil (Dschg Perf) - Walk 50 feet w/2 turns |
| GG0170K1 | Func Mobil (Adm Perf) - Walk 150 feet |
| GG0170K2 | Func Mobil (Dschg Goal) - Walk 150 feet |
| GG0170K3 | Func Mobil (Dschg Perf) - Walk 150 feet |
| GG0170Q1 | Does the patient use a wheelchair and/or scooter |
| GG0170Q3 | Does the patient use a wheelchair and/or scooter |
| GG0170R1 | Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns |
| GG0170R2 | Func Mobil (Dschg Goal) - Wheel 50 feet w/2 turns |
| GG0170R3 | Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns |
| GG0170RR1 | Indicate the type of wheelchair or scooter used |
| GG0170RR3 | Indicate the type of wheelchair or scooter used |
| GG0170S1 | Func Mobil (Adm Perf) - Wheel 150 feet |
| GG0170S2 | Func Mobil (Dschg Goal) - Wheel 150 feet |
| GG0170S3 | Func Mobil (Dschg Perf) - Wheel 150 feet |
| GG0170SS1 | Indicate the type of wheelchair or scooter used |
| GG0170SS3 | Indicate the type of wheelchair or scooter used. |
| H0350 | Bladder continence |
| H0400 | Bowel continence |
| I0050 | Patient primary medical condition |
| I0103 | Metastatic Cancer |
| I0104 | Severe Cancer |
| I0605 | Severe Left Systolic/Ventricular Dysfunction |
| I0900 | Peripheral vascular disease (PVD) or PAD |
| I1501 | Chronic Kidney Disease, Stage 5 |
| I1502 | Acute Renal Failure |
| I2101 | Septicemia, Sepsis, Systemic Inflammatory Response |
| I2600 | CNS Infect, Oppor Infect, Bone/Joint/Muscle Infect |
| I2900 | Diabetes mellitus (DM) |
| I4100 | Major Lower Limb Amputation |
| I4501 | Stroke |
| I4801 | Dementia |
| I4900 | Hemiplegia or Hemiparesis |
| I5000 | Paraplegia |
| I5101 | Complete Tetraplegia |
| I5102 | Incomplete Tetraplegia |
| I5110 | Other Spinal Cord Disorder/Injury |
| I5200 | Multiple Sclerosis (MS) |
| I5250 | Huntington"s Disease |
| I5300 | Parkinson"s Disease |
| I5450 | Amyotrophic Lateral Sclerosis |
| I5455 | Other Progressive Neuromuscular Disease |
| I5460 | Locked-In State |
| I5470 | Severe Anoxic Brain Damage, Cerebral Edema |
| I5480 | Other Severe Neurological Injury-Disease-Dysfunc |
| I5601 | Malnutrition |
| I5602 | At Risk for Malnutrition |
| I7100 | Lung Transplant |
| I7101 | Heart Transplant |
| I7102 | Liver Transplant |
| I7103 | Kidney Transplant |
| I7104 | Bone Marrow Transplant |
| I7900 | None of the Above |
| J0510 | Pain effect on sleep |
| J0520 | Pain interference with therapy activities |
| J0530 | Pain interference with day-to-day activities |
| J1800 | Any Falls Since Admission |
| J1900A | Num Falls Since Admission - No injury |
| J1900B | Num Falls Since Admission - Injury (except major) |
| J1900C | Num Falls Since Admission - Major injury |
| K0520A1 | Nutritional approach (Admission): Parenteral |
| K0520A4 | Nutritional approaches (7 days): Parenteral |
| K0520A5 | Nutritional approaches (discharge): Parenteral |
| K0520B1 | Nutritional approaches (admission): Feeding tube |
| K0520B4 | Nutritional approaches (7 days): Feeding tube |
| K0520B5 | Nutritional approaches (discharge): Feeding Tube |
| K0520C1 | Nutritional approaches (admission) : Mechanically |
| K0520C4 | Nutritional approaches (7 days): mech altered diet |
| K0520C5 | Nutritional approaches (discharge): mech altered |
| K0520D1 | Nutritional approaches (admission) : Therapeutic |
| K0520D4 | Nutritional approaches (7 day): Therapeutic diet |
| K0520D5 | Nutritional approaches (discharge): Therapeutic |
| K0520Z1 | Nutritional approaches (admission) : None |
| K0520Z4 | Nutritional approaches (7 days): None |
| K0520Z5 | Nutritional approaches (discharge): None |
| M0210 | Patient has 1+ unhealed pressure ulcers/injuries |
| N0415A1 | High-Risk Drug (Is Taking): Antipsychotic |
| N0415A2 | High-Risk Drug (Indication) : Antipsychotic |
| N0415E1 | High-Risk Drug (Is taking): Anticoagulant |
| N0415E2 | High-Risk Drug (Indication): Anticoagulant |
| N0415F1 | High-Risk Drug (Is taking): Antibiotic |
| N0415F2 | High-Risk Drug (Indication): Antibiotic |
| N0415H1 | High-Risk Drug (Is taking): Opioid |
| N0415H2 | High-Drug Risk (Indication): Opioid |
| N0415I1 | High-Risk Drug (Is taking): Antiplatelet |
| N0415I2 | High-Risk Drug (Indication): Antiplatelet |
| N0415J1 | High-Risk Drug (Is taking): Hypoglycemic |
| N0415J2 | High-Risk Drug (Indication): Hypoglycemic |
| N0415Z1 | High-Risk Drug (Is taking): None of the above |
| N2001 | Drug Regimen Review |
| N2003 | Medication Follow-up |
| N2005 | Medication Intervention |
| O0110A1a | Treatment: Chemotherapy (Admission) |
| O0110A2a | Treatment: IV (Admission) |
| O0110A3a | Treatment: Oral (Admission) |
| O0110A10a | Treatment: Other (Admission) |
| O0110B1a | Treatment: Radiation (Admission) |
| O0110C1a | Therapies: Oxygen Therapy (Admission) |
| O0110C2a | Therapies: Continuous (Admission) |
| O0110C3a | Therapies: Intermittent (Admission) |
| O0110C4a | Therapies: High-concentration (Admission) |
| O0110D1a | Therapies: Suctioning (Admission) |
| O0110D2a | Therapies: Scheduled |
| O0110D3a | Therapies: As Needed (Admission) |
| O0110E1a | Therapies: Tracheostomy Care (Admission) |
| O0110G1a | Therapies: Non-Invas Mechanical Ventilator (Admis) |
| O0110G2a | Therapies: BiPAP (Admission) |
| O0110G3a | Therapies: CPAP (Admission) |
| O0110A1c | Treatment: Chemotherapy (Discharge) |
| O0110A2c | Treatment: IV (Discharge) |
| O0110A3c | Treatment: Oral (Discharge) |
| O0110A10c | Treatment: Other (Discharge) |
| O0110B1c | Treatment: Radiation (Discharge) |
| O0110C1c | Therapies: Oxygen Therapy (Discharge) |
| O0110C2c | Therapies: Continuous (Discharge) |
| O0110C3c | Therapies: Intermittent (Discharge) |
| O0110C4c | Therapies: High-concentration (Discharge) |
| O0110D1c | Therapies: Suctioning (Discharge) |
| O0110D2c | Therapies: Scheduled (Discharge) |
| O0110D3c | Therapies: As Needed (Discharge) |
| O0110E1c | Therapies: Tracheostomy Care (Discharge) |
| O0110G1c | Therapies: Non-Invas Mechanical Ventilator (Disch) |
| O0110G2c | Therapies: BiPAP (Discharge) |
| O0110G3c | Therapies: CPAP (Discharge) |
| O0110F1c | Therapies: Invasive Mechanical Ventilator (Disch) |
| O0110H1c | Other: IV Medications (Discharge) |
| O0110H2c | Other: Vasoactive medications (Discharge) |
| O0110H3c | Other: Antibiotics (Discharge) |
| O0110H4c | Other: Anticoagulation (Discharge) |
| O0110H10c | Other: Other (Discharge) |
| O0110I1c | Other: Transfusions (Discharge) |
| O0110J1c | Other: Dialysis (Discharge) |
| O0110J2c | Other: Hemodialysis (Discharge) |
| O0110J3c | Other: Peritoneal dialysis (Discharge) |
| O0110Z1c | Other: None of the above (Discharge) |
| O0150A | SBT: Invasive Mechanical Ventilation Support |
| O0150B | SBT: Assessed for readiness by day 2 |
| O0150C | SBT: Deemed medically ready by day 2 |
| O0150D | SBT: Documentation of reason(s) - patient unready |
| O0150E | SBT: Performed by day 2 |
| O0200A | Invasive Mechanical Ventilator - Liberation Status |
| O0250A | Was influenza vaccine received |
| O0250C | If influenza vaccine not received, state reason |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 02/29/2020 10:39:12 PM