-5004
| Property | Specification |
| Data System | IRF-PAI |
| Data Specs | V2.01.1 |
| Edit Type | Consistency |
| Severity | Warning |
| Edit Text | Entering a dash as a response to any Quality Measure item may result in a payment reduction of two percentage points for the applicable FY annual increase factor. |
| Version Notes | [V2.01.0]-Removed mappings to the following items: J1900A, J1900B, M0300A1_1, M0300A1_2, M0300E1_2, M0300F1_2, M0300G1_2, M0800D, M0800E, M0800F, M0900A1, M0900B, M0900C, M0900D. |
| Item List | |
| Item ID | Description |
| 25A | Height |
| 26A | Weight |
| BB0700 | Expression of Ideas and Wants (3-day asmt period) |
| BB0800 | Understanding Verbal Content (3-day asmt period) |
| C0100 | Brief Interview - Mental Status (BIMS) |
| C0200 | BIMS - Repetition of Three Words |
| C0300A | BIMS - Temporal Orientation - Year |
| C0300B | BIMS - Temporal Orientation - Month |
| C0300C | BIMS - Temporal Orientation - Day |
| C0500 | BIMS - Summary Score |
| C0600 | Conduct Staff Assessment - Mental Status |
| C0900A | Memory/Recall Ability - Current Season |
| C0900B | Memory/Recall Ability - Location Of Own Room |
| C0900C | Memory/Recall Ability - Staff Names and Faces |
| C0900E | Memory/Recall Ability - In Hospital unit |
| C0900Z | Memory/Recall Ability - None Of The Above |
| GG0100A | Prior Function - Self Care |
| GG0100B | Prior Function - Indoor Mobility (Ambulation) |
| GG0100C | Prior Function - Stairs |
| GG0100D | Prior Function - Functional Cognition |
| GG0110A | Prior Device - Manual wheelchair |
| GG0110B | Prior Device - Motorized wheelchair or scooter |
| GG0110C | Prior Device - Mechanical lift |
| GG0110D | Prior Device - Walker |
| GG0110E | Prior Device - Orthotics/Prosthetics |
| GG0110Z | Prior Device - None of the above |
| GG0130A1 | Self-Care (Adm Perf) - Eating |
| GG0130A3 | Self-Care (Dschg Perf) - Eating |
| GG0130B1 | Self-Care (Adm Perf) - Oral hygiene |
| GG0130B3 | Self-Care (Dschg Perf) - Oral hygiene |
| GG0130C1 | Self-Care (Adm Perf) - Toileting hygiene |
| GG0130C3 | Self-Care (Dschg Perf) - Toileting hygiene |
| GG0130E1 | Self-Care (Adm Perf) - Shower/bathe self |
| GG0130E3 | Self-Care (Dschg Perf) - Shower/bathe self |
| GG0130F1 | Self-Care (Adm Perf) - Upper Body Dressing |
| GG0130F3 | Self-Care (Dschg Perf) - Upper Body Dressing |
| GG0130G1 | Self-Care (Adm Perf) - Lower Body Dressing |
| GG0130G3 | Self-Care (Dschg Perf) - Lower Body Dressing |
| GG0130H1 | Self-Care (Adm Perf) - On/Off Footwear |
| GG0130H3 | Self-Care (Dschg Perf) - On/Off Footwear |
| GG0170A1 | Func Mobil (Adm Perf) - Roll left and right |
| GG0170A3 | Func Mobil (Dschg Perf) - Roll left and right |
| GG0170B1 | Func Mobil (Adm Perf) - Sit to lying |
| GG0170B3 | Func Mobil (Dschg Perf) - Sit to lying |
| GG0170C1 | Func Mobil (Adm Perf) - Lying to sit on side |
| GG0170C3 | Func Mobil (Dschg Perf) - Lying to sitting on side |
| GG0170D1 | Func Mobil (Adm Perf) - Sit to stand |
| GG0170D3 | Func Mobil (Dschg Perf) - Sit to stand |
| GG0170E1 | Func Mobil (Adm Perf) - Chair/bed-to-chair trans |
| GG0170E3 | Func Mobil (Dschg Perf) - Chair/bed-to-chair trans |
| GG0170F1 | Func Mobil (Adm Perf) - Toilet transfer |
| GG0170F3 | Func Mobil (Dschg Perf) - Toilet transfer |
| GG0170G1 | Func Mobil (Adm Perf) - Car Transfer |
| GG0170G3 | Func Mobil (Dschg Perf) - Car Transfer |
| GG0170H1 | Does the patient walk (Adm) |
| GG0170H3 | Does the patient walk (Dschg) |
| GG0170I1 | Func Mobil (Adm Perf) - Walk 10 feet |
| GG0170I3 | Func Mobil (Dschg Perf) - Walk 10 feet |
| GG0170J1 | Func Mobil (Adm Perf) - 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 |
| GG0170K3 | Func Mobil (Dschg Perf) - Walk 150 feet |
| GG0170L1 | Func Mobil (Adm Perf) - Walk 10 Ft Uneven Surf |
| GG0170L3 | Func Mobil (Dschg Perf) - Walk 10 Ft Uneven Surf |
| GG0170M1 | Func Mobil (Adm Perf) - 1 Step (Curb) |
| GG0170M3 | Func Mobil (Dschg Perf) - 1 Step (Curb) |
| GG0170N1 | Func Mobil (Adm Perf) - 4 Steps |
| GG0170N3 | Func Mobil (Dschg Perf) - 4 Steps |
| GG0170O1 | Func Mobil (Adm Perf) - 12 Steps |
| GG0170O3 | Func Mobil (Dschg Perf) - 12 Steps |
| GG0170P1 | Func Mobil (Adm Perf) - Picking Up Object |
| GG0170P3 | Func Mobil (Dschg Perf) - Picking Up Object |
| GG0170Q1 | Does the patient use a wheelchair/scooter (Adm) |
| GG0170Q3 | Does the patient use a wheelchair/scooter (Dschg) |
| GG0170R1 | Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns |
| GG0170R3 | Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns |
| GG0170RR1 | Indicate the type of wheelchair/scooter (Adm) |
| GG0170RR3 | Indicate the type of wheelchair/scooter (Dschg) |
| GG0170S1 | Func Mobil (Adm Perf) - Wheel 150 feet |
| GG0170S3 | Func Mobil (Dschg Perf) - Wheel 150 feet |
| GG0170SS1 | Indicate the type of wheelchair/scooter (Adm) |
| GG0170SS3 | Indicate the type of wheelchair/scooter (Dschg) |
| H0350 | Bladder continence |
| H0400 | Bowel continence |
| I0900 | Diagnoses: Peripheral vascular disease (PVD)/PAD |
| I2900 | Diagnoses: Diabetes mellitus (DM) |
| I7900 | Diagnoses: None of the Above |
| J1750 | History Of Falls |
| J1800 | Any Falls Since Admission |
| J1900C | Num Falls Since Admission - Major injury |
| J2000 | Prior Surgery |
| K0110A | Swallow/Nutrit - Regular Food |
| K0110B | Swallow/Nutrit - Modified Food |
| K0110C | Swallow/Nutrit - Tube/Parenteral Feeding |
| M0210_1 | Pressure Ulcers Present on Admission |
| M0210_2 | Pressure Ulcers Present on Discharge |
| M0300B1_1 | Number of Stage 2 pressure ulcers: Admission |
| M0300B1_2 | Number of Stage 2 pressure ulcers: Discharge |
| M0300C1_1 | Number of Stage 3 pressure ulcers: Admission |
| M0300C1_2 | Number of Stage 3 pressure ulcers: Discharge |
| M0300D1_1 | Number of Stage 4 pressure ulcers: Admission |
| M0300D1_2 | Number of Stage 4 pressure ulcers: Discharge |
| M0300E1_1 | Nbr Unstg non-remov drsg pressure ulcers: Adm |
| M0300F1_1 | Nbr Unstg slough/eschar pressure ulcers: Adm |
| M0300G1_1 | Nbr Unstg DTI pressure ulcers: Adm |
| M0800A | Worsened: Stage 2 pressure ulcers |
| M0800B | Worsened: Stage 3 pressure ulcers |
| M0800C | Worsened: Stage 4 pressure ulcers |
| O0100N | Total Parenteral Nutrition |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 08/17/2017 04:43:12 PM