-5004
Property | Specification |
Data System | IRF-PAI |
Data Specs | V5.00.0 DRAFT |
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 |
[V5.00.0] - Mapped following new items: A1110A, B0200, B1000, C0100, C0100_2, C0200, C0200_2, C0300A, C0300A_2, C0300B, C0300B_2, C0300C, C0300C_2, C0400A, C0400A_2, C0400B, C0400B_2, C0400C, C0400C_2, C0500, C0500_2, C1310A_1, C1310A_2, C1310B_1, C1310B_2, C1310C_1, C1310C_2, C1310D_1, C1310D_2, D0150A1_1, D0150A1_2, D0150A2_1, D0150A2_2, D0150B1_1, D0150B1_2, D0150B2_1, D0150B2_2, D0150C1_1, D0150C1_2, D0150C2_1, D0150C2_2, D0150D1_1, D0150D1_2, D0150D2_1, D0150D2_2, D0150E1_1, D0150E1_2, D0150E2_1, D0150E2_2, D0150F1_1, D0150F1_2, D0150F2_1, D0150F2_2, D0150G1_1, D0150G1_2, D0150G2_1, D0150G2_2, D0150H1_1, D0150H1_2, D0150H2_1, D0150H2_2, D0150I1_1, D0150I1_2, D0150I2_1, D0150I2_2, D0160_1, D0160_2, K0520A1, K0520A4, K0520A5, K0520B1, K0520B4, K0520B5, K0520C1, K0520C4, K0520C5, K0520D1, K0520D4, K0520D5, K0520Z1, K0520Z4, K0520Z5, N0415A1_1, N0415A1_2, N0415A2_1, N0415A2_2, N0415E1_1, N0415E1_2, N0415E2_1, N0415E2_2, N0415F1_1, N0415F1_2, N0415F2_1, N0415F2_2, N0415H1_1, N0415H1_2, N0415H2_1, N0415H2_2, N0415I1_1, N0415I1_2, N0415I2_1, N0415I2_2, N0415J1_1, N0415J1_2, N0415J2_1, N0415J2_2, N0415Z1_1, N0415Z1_2, O0110A1a, O0110A1c, O0110A2a, O0110A2c, O0110A3a, O0110A3c, O0110A10a, O0110A10c, O0110B1a, O0110B1c, O0110C1a, O0110C1c, O0110C2a, O0110C2c, O0110C3a, O0110C3c, O0110C4a, O0110C4c, O0110D1a, O0110D1c, O0110D2a, O0110D2c, O0110D3a, O0110D3c, O0110E1a, O0110E1c, O0110F1a, O0110F1c, O0110G1a, O0110G1c, O0110G2a, O0110G2c, O0110G3a, O0110G3c, O0110H1a, O0110H1c, O0110H2a, O0110H2c, O0110H3a, O0110H3c, O0110H4a, O0110H4c, O0110H10a, O0110H10c, O0110I1a, O0110I1c, O0110J1a, O0110J1c, O0110J2a, O0110J2c, O0110J3a, O0110J3c, O0110O1a, O0110O1c, O0110O2a, O0110O2c, O0110O3a, O0110O3c, O0110O4a, O0110O4c, O0110Z1a, O0110Z1c |
Item List | |
Item ID | Description |
25A | Height |
26A | Weight |
A1110A | Preferred language |
B0200 | Hearing |
B1000 | Vision |
C0100 | Brief Interview - Mental Status (BIMS) |
C0100_2 | Brief Interview - Mental Status (BIMS) |
C0200 | BIMS - Repetition of Three Words |
C0200_2 | BIMS - Repetition of Three Words |
C0300A | BIMS - Temporal Orientation - Year |
C0300A_2 | BIMS - Temporal Orientation - Year |
C0300B | BIMS - Temporal Orientation - Month |
C0300B_2 | BIMS - Temporal Orientation - Month |
C0300C | BIMS - Temporal Orientation - Day |
C0300C_2 | BIMS - Temporal Orientation - Day |
C0400A | BIMS - Recalls Sock |
C0400A_2 | BIMS - Recalls Sock |
C0400B | BIMS - Recalls Blue |
C0400B_2 | BIMS - Recalls Blue |
C0400C | BIMS - Recalls Bed |
C0400C_2 | BIMS - Recalls Bed |
C0500 | BIMS - Summary Score |
C0500_2 | BIMS - Summary Score |
C1310A_1 | Acute Onset Mental Status Change |
C1310A_2 | Acute Onset Mental Status Change |
C1310B_1 | Inattention |
C1310B_2 | Inattention |
C1310C_1 | Disorganized thinking |
C1310C_2 | Disorganized thinking |
C1310D_1 | Altered level of consciousness |
C1310D_2 | Altered level of consciousness |
D0150A1_1 | Little interest or pleasure in doing things: Presc |
D0150A2_1 | Little interest or pleasure in doing things: Freq |
D0150A1_2 | Little interest or pleasure in doing things: Presc |
D0150A2_2 | Little interest or pleasure in doing things: Freq |
D0150B1_1 | Feeling down, depressed, or hopeless: Presc |
D0150B2_1 | Feeling down, depressed, or hopeless: Freq |
D0150B1_2 | Feeling down, depressed, or hopeless: Presc |
D0150B2_2 | Feeling down, depressed, or hopeless: Freq |
D0150C1_1 | Trouble falling or staying asleep: Presc |
D0150C2_1 | Trouble falling or staying asleep: Freq |
D0150C1_2 | Trouble falling or staying asleep: Presc |
D0150C2_2 | Trouble falling or staying asleep: Freq |
D0150D1_1 | Feeling tired or having little energy: Presc |
D0150D2_1 | Feeling tired or having little energy: Freq |
D0150D1_2 | Feeling tired or having little energy: Presc |
D0150D2_2 | Feeling tired or having little energy: Freq |
D0150E1_1 | Poor appetite or overeating: Presc |
D0150E2_1 | Poor appetite or overeating: Freq |
D0150E1_2 | Poor appetite or overeating: Presc |
D0150E2_2 | Poor appetite or overeating: Freq |
D0150F1_1 | Feeling bad about yourself: Presc |
D0150F2_1 | Feeling bad about yourself: Freq |
D0150F1_2 | Feeling bad about yourself: Presc |
D0150F2_2 | Feeling bad about yourself: Freq |
D0150G1_1 | Trouble concentrating on things: Presc |
D0150G2_1 | Trouble concentrating on things: Freq |
D0150G1_2 | Trouble concentrating on things: Presc |
D0150G2_2 | Trouble concentrating on things: Freq |
D0150H1_1 | Moving or speaking so slowly: Presc |
D0150H2_1 | Moving or speaking so slowly: Freq |
D0150H1_2 | Moving or speaking so slowly: Presc |
D0150H2_2 | Moving or speaking so slowly: Freq |
D0150I1_1 | Thoughts that you would be better off dead: Presc |
D0150I2_1 | Thoughts that you would be better off dead: Freq |
D0150I1_2 | Thoughts that you would be better off dead: Presc |
D0150I2_2 | Thoughts that you would be better off dead: Freq |
D0160_1 | Total Severity Score |
D0160_2 | Total Severity Score |
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 |
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 patient use wheelchair and/or scooter (Adm) |
GG0170Q3 | Does patient use wheelchair and/or 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 type of wheelchair or scooter (Adm) |
GG0170RR3 | Indicate type of wheelchair or scooter (Dschg) |
GG0170S1 | Func Mobil (Adm Perf) - Wheel 150 feet |
GG0170S3 | Func Mobil (Dschg Perf) - Wheel 150 feet |
GG0170SS1 | Indicate type of wheelchair or scooter (Adm) |
GG0170SS3 | Indicate type of wheelchair or scooter (Dschg) |
H0400 | Bowel Continence |
I0900 | Diagnoses: Peripheral vascular disease (PVD)/PAD |
I2900 | Diagnoses: Diabetes mellitus (DM) |
J1900C | Num Falls Since Admission - Major injury |
K0520A1 | Nutritional approach: Parenteral |
K0520A4 | Nutritional approaches (7 days): Parenteral |
K0520A5 | Nutritional approaches (discharge): Parenteral |
K0520B1 | Nutritional approaches: Feeding tube |
K0520B4 | Nutritional approaches (7 days): Feeding tube |
K0520B5 | Nutritional approaches (discharge): Feeding Tube |
K0520C1 | Nutritional approaches: Mechanically altered diet |
K0520C4 | Nutritional approaches (7 days): mech altered diet |
K0520C5 | Nutritional approaches (discharge): mech altered |
K0520D1 | Nutritional approaches: Therapeutic diet |
K0520D4 | Nutritional approaches (7 day): Therapeutic diet |
K0520D5 | Nutritional approaches (discharge): Therapeutic |
K0520Z1 | Nutritional approaches: None of the above |
K0520Z4 | Nutritional approaches (7 days): None |
K0520Z5 | Nutritional approaches (discharge): None |
M0300B1_2 | Number of Stage 2 pressure ulcers: Discharge |
M0300B2_2 | Nbr Disch Stg 2 PU were Adm Stg 2 PU |
M0300C1_2 | Number of Stage 3 pressure ulcers: Discharge |
M0300C2_2 | Nbr Disch Stg 3 PU were Adm Stg 3 PU |
M0300D1_2 | Number of Stage 4 pressure ulcers: Discharge |
M0300D2_2 | Nbr Disch Stg 4 PU were Adm Stg 4 PU |
M0300E1_2 | Nbr Unstg non-remov drsg prss ulcers/injrs: Dschrg |
M0300E2_2 | Nbr Unstg NRD Disch PU/Injrs present at Adm |
M0300F1_2 | Nbr Unstg slough/eschar pressure ulcers: Dschrg |
M0300F2_2 | Nbr Unstg S/E Disch PU were Adm Unstg S/E PU |
M0300G1_2 | Nbr Unstg DTI pressure injrs: Dschrg |
M0300G2_2 | Nbr Unstg DTI Disch PU/Injrs present at Adm |
N0415A1_1 | High-Risk Drug (Is Taking): Antipsychotic |
N0415A2_1 | High-Risk Drug (Indication) : Antipsychotic |
N0415A1_2 | High-Risk Drug (Is Taking): Antipsychotic |
N0415A2_2 | High-Risk Drug (Indication) : Antipsychotic |
N0415E1_1 | High-Risk Drug (Is taking): Anticoagulant |
N0415E2_1 | High-Risk Drug (Indication): Anticoagulant |
N0415E1_2 | High-Risk Drug (Is taking): Anticoagulant |
N0415E2_2 | High-Risk Drug (Indication): Anticoagulant |
N0415F1_1 | High-Risk Drug (Is taking): Antibiotic |
N0415F2_1 | High-Risk Drug (Indication): Antibiotic |
N0415F1_2 | High-Risk Drug (Is taking): Antibiotic |
N0415F2_2 | High-Risk Drug (Indication): Antibiotic |
N0415H1_1 | High-Risk Drug (Is taking): Opioid |
N0415H2_1 | High-Drug Risk (Indication): Opioid |
N0415H1_2 | High-Risk Drug (Is taking): Opioid |
N0415H2_2 | High-Drug Risk (Indication): Opioid |
N0415I1_1 | High-Risk Drug (Is taking): Antiplatelet |
N0415I2_1 | High-Risk Drug (Indication): Antiplatelet |
N0415I1_2 | High-Risk Drug (Is taking): Antiplatelet |
N0415I2_2 | High-Risk Drug (Indication): Antiplatelet |
N0415J1_1 | High-Risk Drug (Is taking): Hypoglycemic |
N0415J2_1 | High-Risk Drug (Indication): Hypoglycemic |
N0415J1_2 | High-Risk Drug (Is taking): Hypoglycemic |
N0415J2_2 | High-Risk Drug (Indication): Hypoglycemic |
N0415Z1_1 | High-Risk Drug (Is taking): None of the above |
N0415Z1_2 | High-Risk Drug (Is taking): None of the above |
N2001 | Drug Regimen Review |
N2003 | Medication Follow-up |
N2005 | Medication Intervention |
O0110A1a | Treatment: Chemotherapy (Admission) |
O0110A1c | Treatment: Chemotherapy (Discharge) |
O0110A2a | Treatment: IV (Admission) |
O0110A2c | Treatment: IV (Discharge) |
O0110A3a | Treatment: Oral (Admission) |
O0110A3c | Treatment: Oral (Discharge) |
O0110A10a | Treatment: Other (Admission) |
O0110A10c | Treatment: Other (Discharge) |
O0110B1a | Treatment: Radiation (Admission) |
O0110B1c | Treatment: Radiation (Discharge) |
O0110C1a | Therapies: Oxygen Therapy (Admission) |
O0110C1c | Therapies: Oxygen Therapy (Discharge) |
O0110C2a | Therapies: Continuous (Admission) |
O0110C2c | Therapies: Continuous (Discharge) |
O0110C3a | Therapies: Intermittent (Admission) |
O0110C3c | Therapies: Intermittent (Discharge) |
O0110C4a | Therapies: High-concentration (Admission) |
O0110C4c | Therapies: High-concentration (Discharge) |
O0110D1a | Therapies: Suctioning (Admission) |
O0110D1c | Therapies: Suctioning (Discharge) |
O0110D2a | Therapies: Scheduled |
O0110D2c | Therapies: Scheduled (Discharge) |
O0110D3a | Therapies: As Needed (Admission) |
O0110D3c | Therapies: As Needed (Discharge) |
O0110E1a | Therapies: Tracheostomy Care (Admission) |
O0110E1c | Therapies: Tracheostomy Care (Discharge) |
O0110F1a | Therapies: Invasive Mechanical Ventilator (Admis) |
O0110F1c | Therapies: Invasive Mechanical Ventilator (Disch) |
O0110G1a | Therapies: Non-Invas Mechanical Ventilator (Admis) |
O0110G1c | Therapies: Non-Invas Mechanical Ventilator (Disch) |
O0110G2a | Therapies: BiPAP (Admission) |
O0110G2c | Therapies: BiPAP (Discharge) |
O0110G3a | Therapies: CPAP (Admission) |
O0110G3c | Therapies: CPAP (Discharge) |
O0110H1a | Other: IV Medications (Admission) |
O0110H1c | Other: IV Medications (Discharge) |
O0110H2a | Other: Vasoactive medications (Admission) |
O0110H2c | Other: Vasoactive medications (Discharge) |
O0110H3a | Other: Antibiotics (Admission) |
O0110H3c | Other: Antibiotics (Discharge) |
O0110H4a | Other: Anticoagulation (Admission) |
O0110H4c | Other: Anticoagulation (Discharge) |
O0110H10a | Other: Other (Admission) |
O0110H10c | Other: Other (Discharge) |
O0110I1a | Other: Transfusions (Admission) |
O0110I1c | Other: Transfusions (Discharge) |
O0110J1a | Other: Dialysis (Admission) |
O0110J1c | Other: Dialysis (Discharge) |
O0110J2a | Other: Hemodialysis (Admission) |
O0110J2c | Other: Hemodialysis (Discharge) |
O0110J3a | Other: Peritoneal dialysis (Admission) |
O0110J3c | Other: Peritoneal dialysis (Discharge) |
O0110O1a | Other: IV Access (Admission) |
O0110O1c | Other: IV Access (Discharge) |
O0110O2a | Other: Peripheral (Admission) |
O0110O2c | Other: Peripheral (Discharge) |
O0110O3a | Other: Midline (Admission) |
O0110O3c | Other: Midline (Discharge) |
O0110O4a | Other: Central (Admission) |
O0110O4c | Other: Central (Discharge) |
O0110Z1a | Other: None of the above (Admission) |
O0110Z1c | Other: None of the above (Discharge) |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 03/16/2020 09:31:12 AM