LTCH-CARE Item Summary
|
Item |
Group |
Type |
Length |
Fixed Start-End |
Description |
| ASMT_SYS_CD | Control | Code | 10 | 1-10 | Assessment system code |
| ITM_SBST_CD | Control | Code | 3 | 11-13 | Item subset code |
| ITM_SET_VRSN_CD | Control | Code | 10 | 14-23 | Item set version code |
| SPEC_VRSN_CD | Control | Code | 10 | 24-33 | Specifications version code |
| STATE_CD | Control | Code | 2 | 34-35 | Facility"s state postal code |
| FAC_ID | Control | Text | 16 | 36-51 | Assigned facility/provider submission ID |
| SFTWR_VNDR_ID | Control | Text | 9 | 52-60 | Software vendor federal employer tax ID |
| SFTWR_VNDR_NAME | Control | Text | 30 | 61-90 | Software vendor company name |
| SFTWR_VNDR_EMAIL_ADR | Control | Text | 50 | 91-140 | Software vendor email address |
| SFTWR_PROD_NAME | Control | Text | 50 | 141-190 | Software product name |
| SFTWR_PROD_VRSN_CD | Control | Text | 20 | 191-210 | Software product version code |
| CONTROL_ITEMS_FILLER | Filler | Text | 200 | 211-410 | Control items filler |
| A0050 | Asmt | Code | 1 | 411-411 | Type of record |
| A0055 | Asmt | Number | 2 | 412-413 | Correction number |
| A0100A | Asmt | Text | 10 | 414-423 | Facility National Provider Identifier (NPI) |
| A0100B | Asmt | Text | 12 | 424-435 | Facility CMS Certification Number (CCN) |
| A0100C | Asmt | Text | 15 | 436-450 | State provider number |
| A0200 | Asmt | Code | 1 | 451-451 | Type of provider |
| A0210 | Asmt | Date | 8 | 452-459 | Assessment reference date |
| A0220 | Asmt | Date | 8 | 460-467 | Admission date |
| A0250 | Asmt | Code | 2 | 468-469 | Reason for Assessment |
| A0270 | Asmt | Date | 8 | 470-477 | Discharge date |
| A0500A | Asmt | Text | 12 | 478-489 | Patient first name |
| A0500B | Asmt | Text | 1 | 490-490 | Patient middle initial |
| A0500C | Asmt | Text | 18 | 491-508 | Patient last name |
| A0500D | Asmt | Text | 3 | 509-511 | Patient name suffix |
| A0600A | Asmt | Text | 9 | 512-520 | Social Security Number |
| A0600B | Asmt | Text | 12 | 521-532 | Medicare/railroad insurance number |
| A0700 | Asmt | Text | 14 | 533-546 | Medicaid number |
| A0800 | Asmt | Code | 1 | 547-547 | Gender |
| A0900 | Asmt | Date | 8 | 548-555 | Birth Date |
| A1000A | Asmt | Checklist | 1 | 556-556 | Ethnicity: American Indian or Alaska Native |
| A1000B | Asmt | Checklist | 1 | 557-557 | Ethnicity: Asian |
| A1000C | Asmt | Checklist | 1 | 558-558 | Ethnicity: Black or African American |
| A1000D | Asmt | Checklist | 1 | 559-559 | Ethnicity: Hispanic or Latino |
| A1000E | Asmt | Checklist | 1 | 560-560 | Ethnicity: Native Hawaiian/Pacific Islander |
| A1000F | Asmt | Checklist | 1 | 561-561 | Ethnicity: White |
| A1050 | Asmt | Code | 1 | 562-562 | Highest education completed |
| A1100A | Asmt | Code | 1 | 563-563 | Does the patient need or want an interpreter |
| A1100B | Asmt | Text | 15 | 564-578 | Preferred language |
| A1200 | Asmt | Code | 1 | 579-579 | Marital status |
| A1300D | Asmt | Text | 23 | 580-602 | Lifetime occupation(s) |
| A1400A | Asmt | Checklist | 1 | 603-603 | Payer: Medicare (FFS) |
| A1400B | Asmt | Checklist | 1 | 604-604 | Payer: Medicare (managed care/Part C/Mcr Advant.) |
| A1400C | Asmt | Checklist | 1 | 605-605 | Payer: Medicaid (FFS) |
| A1400D | Asmt | Checklist | 1 | 606-606 | Payer: Medicaid (managed care) |
| A1400E | Asmt | Checklist | 1 | 607-607 | Payer: Workers" compensation |
| A1400F | Asmt | Checklist | 1 | 608-608 | Payer: Title programs |
| A1400G | Asmt | Checklist | 1 | 609-609 | Payer: Other Government |
| A1400H | Asmt | Checklist | 1 | 610-610 | Payer: Private insurance/Medigap |
| A1400I | Asmt | Checklist | 1 | 611-611 | Payer: Private managed care |
| A1400J | Asmt | Checklist | 1 | 612-612 | Payer: Self-pay |
| A1400K | Asmt | Checklist | 1 | 613-613 | Payer: No payor source |
| A1400X | Asmt | Checklist | 1 | 614-614 | Payer: Unknown |
| A1400Y | Asmt | Checklist | 1 | 615-615 | Payer: Other |
| A1800 | Asmt | Code | 2 | 616-617 | Admitted from |
| A1810A | Asmt | Checklist | 1 | 618-618 | Last 2 mo: Short-stay acute hospital (IPPS) |
| A1810B | Asmt | Checklist | 1 | 619-619 | Last 2 mo: Community residential setting |
| A1810C | Asmt | Checklist | 1 | 620-620 | Last 2 mo: Long-term care facility (LTC) |
| A1810D | Asmt | Checklist | 1 | 621-621 | Last 2 mo: Skilled nursing facility (SNF) |
| A1810E | Asmt | Checklist | 1 | 622-622 | Last 2 mo: Hospital emergency department |
| A1810F | Asmt | Checklist | 1 | 623-623 | Last 2 mo: Long-term care hospital (LTCH) |
| A1810G | Asmt | Checklist | 1 | 624-624 | Last 2 mo: Inpatient rehabilitation fac/unit(IRF) |
| A1810H | Asmt | Checklist | 1 | 625-625 | Last 2 mo: Home health agency (HHA) |
| A1810I | Asmt | Checklist | 1 | 626-626 | Last 2 mo: Hospice |
| A1810J | Asmt | Checklist | 1 | 627-627 | Last 2 mo: Outpatient services |
| A1810K | Asmt | Checklist | 1 | 628-628 | Last 2 mo: Psychiatric hospital or unit |
| A1810L | Asmt | Checklist | 1 | 629-629 | Last 2 mo: ID/DD facility |
| A1810Z | Asmt | Checklist | 1 | 630-630 | Last 2 mo: None of the above |
| A1820 | Asmt | ICD | 8 | 631-638 | Previous medical setting primary diagnosis |
| A1955 | Asmt | Code | 1 | 639-639 | Discharge delay |
| A1960 | Asmt | Code | 2 | 640-641 | Reason for discharge delay |
| A1970 | Asmt | Code | 1 | 642-642 | Discharge return status |
| A2100 | Asmt | Code | 2 | 643-644 | Discharge location |
| B0100 | Asmt | Code | 1 | 645-645 | Comatose |
| GG0160A | Asmt | Code | 2 | 646-647 | Functional Mobil: Roll left and right |
| GG0160B | Asmt | Code | 2 | 648-649 | Functional Mobil: Sit to lying |
| GG0160C | Asmt | Code | 2 | 650-651 | Functional Mobil: Lying to sitting on side of bed |
| H0400 | Asmt | Code | 1 | 652-652 | Bowel continence |
| I0900 | Asmt | Checklist | 1 | 653-653 | Peripheral vascular disease (PVD) or PAD |
| I2900 | Asmt | Checklist | 1 | 654-654 | Diabetes mellitus (DM) |
| I5600 | Asmt | Checklist | 1 | 655-655 | Malnutrition (protein, calorie), risk of malnutrit |
| K0200A | Asmt | Number | 2 | 656-657 | Height (in inches) |
| K0200B | Asmt | Number | 3 | 658-660 | Weight (in pounds) |
| M0210 | Asmt | Code | 1 | 661-661 | Patient has Stage 1 or higher pressure ulcers |
| M0300A | Asmt | Number | 1 | 662-662 | Stage 1 pressure ulcers: number present |
| M0300B1 | Asmt | Number | 1 | 663-663 | Stage 2 pressure ulcers: number present |
| M0300B2 | Asmt | Number | 1 | 664-664 | Stage 2 pressure ulcers: number at admit |
| M0300B3 | Asmt | Date | 8 | 665-672 | Stage 2 pressure ulcers: date of oldest |
| M0300C1 | Asmt | Number | 1 | 673-673 | Stage 3 pressure ulcers: number present |
| M0300C2 | Asmt | Number | 1 | 674-674 | Stage 3 pressure ulcers: number at admit |
| M0300D1 | Asmt | Number | 1 | 675-675 | Stage 4 pressure ulcers: number present |
| M0300D2 | Asmt | Number | 1 | 676-676 | Stage 4 pressure ulcers: number at admit |
| M0300E1 | Asmt | Number | 1 | 677-677 | Unstageable dressing: number present |
| M0300E2 | Asmt | Number | 1 | 678-678 | Unstageable dressing: number at admit |
| M0300F1 | Asmt | Number | 1 | 679-679 | Unstageable slough/eschar: number present |
| M0300F2 | Asmt | Number | 1 | 680-680 | Unstageable slough/eschar: number at admit |
| M0300G1 | Asmt | Number | 1 | 681-681 | Unstageable deep tissue: number present |
| M0300G2 | Asmt | Number | 1 | 682-682 | Unstageable deep tissue: number at admit |
| M0610A | Asmt | Number | 4 | 683-686 | Stage 3 or 4 pressure ulcer length |
| M0610B | Asmt | Number | 4 | 687-690 | Stage 3 or 4 pressure ulcer width |
| M0610C | Asmt | Number | 4 | 691-694 | Stage 3 or 4 pressure ulcer depth |
| M0700 | Asmt | Code | 1 | 695-695 | Most severe tissue type for any pressure ulcer |
| M0800A | Asmt | Number | 1 | 696-696 | Worsened since prior asmt: Stage 2 pressure ulcers |
| M0800B | Asmt | Number | 1 | 697-697 | Worsened since prior asmt: Stage 3 pressure ulcers |
| M0800C | Asmt | Number | 1 | 698-698 | Worsened since prior asmt: Stage 4 pressure ulcers |
| Z0500B | Asmt | Date | 8 | 699-706 | Date assessment signed as complete |
| ASMT_ITEMS_FILLER | Filler | Text | 1000 | 707-1706 | Assessment items filler |
| ASSESSMENT_ID | Calc | Number | 15 | 1707-1721 | Assessment internal ID |
| ORIGINAL_ASSESSMENT_ID | Calc | Number | 15 | 1722-1736 | Original assessment ID |
| RESIDENT_INTERNAL_ID | Calc | Number | 10 | 1737-1746 | Patient internal ID |
| TARGET_DATE | Calc | Date | 8 | 1747-1754 | Target date |
| PROVIDER_INTERNAL_ID | Calc | Number | 10 | 1755-1764 | Provider internal ID |
| SUBMISSION_ID | Calc | Number | 15 | 1765-1779 | Submission ID |
| SUBMISSION_DATE | Calc | Date | 8 | 1780-1787 | Submission date |
| SUBMISSION_COMPLETE_DATE | Calc | Date | 8 | 1788-1795 | Submission processing completion date |
| SUBMITTING_USER_ID | Calc | Text | 30 | 1796-1825 | Submitter user ID |
| RESIDENT_MATCH_CRITERIA | Calc | Number | 2 | 1826-1827 | Resident matching criteria |
| RESIDENT_AGE | Calc | Number | 3 | 1828-1830 | Age of patient on the target date |
| BIRTHDATE_SUBMIT_CODE | Calc | Code | 1 | 1831-1831 | Birth date submit code |
| CALCULATED_ITEMS_FILLER | Filler | Text | 437 | 1832-2268 | Calculated items filler |
| DATA_END_INDICATOR | Calc | Code | 1 | 2269-2269 | End of data terminator code |
| CR | Calc | Code | 1 | 2270-2270 | Carriage return (ASCII 013) |
| LF | Calc | Code | 1 | 2271-2271 | Line feed character (ASCII 010) |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 07/12/2012 12:51:39 PM