-1009
| Property | Specification |
| Data System | LTCH |
| Data Specs | V1.00.3 |
| 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 | (v1.00.2) Reworded text by removing last sentence. (v1.00.1) Reworded edit text by removing subtitle. |
| 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 |
| A1050 | Highest education completed |
| 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 |
| A1800 | Admitted from |
| A1810A | Last 2 mo: Short-stay acute hospital (IPPS) |
| A1810B | Last 2 mo: Community residential setting |
| A1810C | Last 2 mo: Long-term care facility (LTC) |
| A1810D | Last 2 mo: Skilled nursing facility (SNF) |
| A1810E | Last 2 mo: Hospital emergency department |
| A1810F | Last 2 mo: Long-term care hospital (LTCH) |
| A1810G | Last 2 mo: Inpatient rehabilitation fac/unit(IRF) |
| A1810H | Last 2 mo: Home health agency (HHA) |
| A1810I | Last 2 mo: Hospice |
| A1810J | Last 2 mo: Outpatient services |
| A1810K | Last 2 mo: Psychiatric hospital or unit |
| A1810L | Last 2 mo: ID/DD facility |
| A1810Z | Last 2 mo: None of the above |
| A1955 | Discharge delay |
| A1960 | Reason for discharge delay |
| A1970 | Discharge return status |
| A2100 | Discharge location |
| B0100 | Comatose |
| GG0160A | Functional Mobil: Roll left and right |
| GG0160B | Functional Mobil: Sit to lying |
| GG0160C | Functional Mobil: Lying to sitting on side of bed |
| H0400 | Bowel continence |
| I0900 | Peripheral vascular disease (PVD) or PAD |
| I2900 | Diabetes mellitus (DM) |
| I5600 | Malnutrition (protein, calorie), risk of malnutrit |
| M0210 | Patient has Stage 1 or higher pressure ulcers |
| M0700 | Most severe tissue type for any pressure ulcer |
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Generated: 07/12/2012 12:51:39 PM