-1009
| Property | Specification |
| Data System | LTCH |
| Data Specs | V2.01.0 |
| 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 |
| 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 |
| 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 |
| A1100A | Does the patient need or want an interpreter |
| A1200 | Marital status |
| 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 payor source |
| A1400X | Payer: Unknown |
| A1400Y | Payer: Other |
| A1802 | Admitted from |
| A2110 | Discharge location |
| A2500 | Were there program interruption(s) during stay |
| B0100 | Comatose |
| BB0700 | Expression of Ideas and Wants (3-day asmt period) |
| BB0800 | Understanding Verbal Content (3-day asmt period) |
| C1610A | Acute onset |
| C1610B | Fluctuating Course |
| C1610C | Inattention |
| C1610D | Disorganized Thinking |
| C1610E1 | Altered Consc Lvl - Alert |
| C1610E2 | Altered Consc Lvl - Vigilant/Lethargic/Stupor/Coma |
| GG0100B | Indoor Mobility (Ambulation) |
| GG0110A | Manual wheelchair |
| GG0110B | Motorized wheelchair 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 sit 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 |
| GG0170H1 | Does the patient walk |
| GG0170H3 | Does the patient walk |
| 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/scooter |
| GG0170Q3 | Does the patient use a wheelchair/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/scooter used |
| GG0170RR3 | Indicate the type of wheelchair/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/scooter used |
| GG0170SS3 | Indicate the type of wheelchair/scooter used. |
| H0350 | Bladder continence |
| H0400 | Bowel continence |
| I0050 | Patient primary medical condition |
| I0101 | Severe and Metastatic Cancers |
| 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 |
| I5460 | Locked-In State |
| I5470 | Severe Anoxic Brain Damage, Cerebral Edema |
| I5601 | Malnutrition |
| I5602 | At Risk for Malnutrition |
| I7900 | None of the Above |
| 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 |
| M0210 | Patient has Stage 1 or higher pressure ulcers |
| O0100F3 | Invasive Mechanical Ventilator - weaning |
| O0100F4 | Invasive Mechanical Ventilator - non-weaning |
| O0100G | Non-invasive ventilator (BIPAP, CPAP) |
| O0100J | Dialysis |
| O0100N | Total Parenteral Nutrition |
| O0100Z | None of the above |
| O0250A | Was influenza vaccine received |
| O0250C | If influenza vaccine not received, state reason |
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Generated: 04/21/2016 03:34:11 PM