-5004


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Property Specification
Data System IRF-PAI
Data Specs V5.02.1
Edit Type Consistency
Severity Warning
Edit Text A dash (-) submitted in this item may result in a payment reduction for your facility of two percentage points for the applicable FY annual increase factor.
Version Notes [V5.02.0]-Added mapping to new item O0350. Added mappings to the M0300 admission items. Removed mappings to D0160_1 and D0160_2.

Item List
Item ID Description
25A Height
26A Weight
A1110A Preferred language
B0200 Hearing
B1000 Vision
C0100 Brief Interview - Mental Status (BIMS) (Adm)
C0100_2 Brief Interview - Mental Status (BIMS) (Dsch)
C0200 BIMS - Repetition of Three Words (Adm)
C0200_2 BIMS - Repetition of Three Words (Dsch)
C0300A BIMS - Temporal Orientation - Year (Adm)
C0300A_2 BIMS - Temporal Orientation - Year (Dsch)
C0300B BIMS - Temporal Orientation - Month (Adm)
C0300B_2 BIMS - Temporal Orientation - Month (Dsch)
C0300C BIMS - Temporal Orientation - Day (Adm)
C0300C_2 BIMS - Temporal Orientation - Day (Dsch)
C0500 BIMS - Summary Score (Adm)
C0500_2 BIMS - Summary Score (Dsch)
C1310A_1 Delirium: Acute Onset Mental Status Change (Adm)
C1310A_2 Delirium: Acute Onset Mental Status Change (Dsch)
C1310B_1 Delirium: Inattention (Adm)
C1310B_2 Delirium: Inattention (Dsch)
C1310C_1 Delirium: Disorganized thinking (Adm)
C1310C_2 Delirium: Disorganized thinking (Dsch)
C1310D_1 Delirium: Altered level of consciousness (Adm)
C1310D_2 Delirium: Altered level of consciousness (Dsch)
D0150A1_1 Mood: Little interest/pleasure doing things: P (A)
D0150A1_2 Mood: Little interest/pleasure doing things: P (D)
D0150B1_1 Mood: Feeling down, depressed, or hopeless: P (A)
D0150B1_2 Mood: Feeling down, depressed, or hopeless: P (D)
D0150C1_1 Mood: Trouble falling or staying asleep: P (A)
D0150C1_2 Mood: Trouble falling or staying asleep: P (D)
D0150D1_1 Mood: Feeling tired or having little energy: P (A)
D0150D1_2 Mood: Feeling tired or having little energy: P (D)
D0150E1_1 Mood: Poor appetite or overeating: P (A)
D0150E1_2 Mood: Poor appetite or overeating: P (D)
D0150F1_1 Mood: Feeling bad about yourself: P (A)
D0150F1_2 Mood: Feeling bad about yourself: P (D)
D0150G1_1 Mood: Trouble concentrating on things: P (A)
D0150G1_2 Mood: Trouble concentrating on things: P (D)
D0150H1_1 Mood: Moving or speaking so slowly: P (A)
D0150H1_2 Mood: Moving or speaking so slowly: P (D)
D0150I1_1 Mood: Thoughts of better off dead: P (A)
D0150I1_2 Mood: Thoughts of better off dead: P (D)
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 Approaches (Admission): Parenteral
K0520A4 Nutritional Approaches (7 days): Parenteral
K0520A5 Nutritional Approaches (Discharge): Parenteral
K0520B1 Nutritional Approaches (Admission): Feeding tube
K0520B4 Nutritional Approaches (7 days): Feeding tube
K0520B5 Nutritional Approaches (Discharge): Feeding Tube
K0520C1 Nutritional Approaches (Admission) : Mech Alt Diet
K0520C4 Nutritional Approaches (7 days): Mech Alt Diet
K0520C5 Nutritional Approaches (Discharge): Mech Alt Diet
K0520D1 Nutritional Approaches (Admission) : Therapeutic
K0520D4 Nutritional Approaches (7 day): Therapeutic
K0520D5 Nutritional Approaches (Discharge): Therapeutic
K0520Z1 Nutritional Approaches (Admission) : None
K0520Z4 Nutritional Approaches (7 days): None
K0520Z5 Nutritional Approaches (Discharge): None
M0300B1_1 Number of Stage 2 pressure ulcers: Admission
M0300B1_2 Number of Stage 2 pressure ulcers: Discharge
M0300B2_2 Nbr Disch Stg 2 PU were Adm Stg 2 PU
M0300C1_1 Number of Stage 3 pressure ulcers: Admission
M0300C1_2 Number of Stage 3 pressure ulcers: Discharge
M0300C2_2 Nbr Disch Stg 3 PU were Adm Stg 3 PU
M0300D1_1 Number of Stage 4 pressure ulcers: Admission
M0300D1_2 Number of Stage 4 pressure ulcers: Discharge
M0300D2_2 Nbr Disch Stg 4 PU were Adm Stg 4 PU
M0300E1_1 Nbr Unstg non-remov drsg prss ulcers/injrs: Adm
M0300E1_2 Nbr Unstg non-remov drsg prss ulcers/injrs: Dschrg
M0300E2_2 Nbr Unstg NRD Disch PU/Injrs present at Adm
M0300F1_1 Nbr Unstg slough/eschar pressure ulcers: 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_1 Nbr Unstg DTI pressure injrs: Adm
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 (Adm)
N0415A1_2 High-Risk Drug (Is Taking): Antipsychotic (Dsch)
N0415A2_1 High-Risk Drug (Indication) : Antipsychotic (Adm)
N0415A2_2 High-Risk Drug (Indication) : Antipsychotic (Dsch)
N0415E1_1 High-Risk Drug (Is taking): Anticoagulant (Adm)
N0415E1_2 High-Risk Drug (Is taking): Anticoagulant (Dsch)
N0415E2_1 High-Risk Drug (Indication): Anticoagulant (Adm)
N0415E2_2 High-Risk Drug (Indication): Anticoagulant (Dsch)
N0415F1_1 High-Risk Drug (Is taking): Antibiotic (Adm)
N0415F1_2 High-Risk Drug (Is taking): Antibiotic (Dsch)
N0415F2_1 High-Risk Drug (Indication): Antibiotic (Adm)
N0415F2_2 High-Risk Drug (Indication): Antibiotic (Dsch)
N0415H1_1 High-Risk Drug (Is taking): Opioid (Adm)
N0415H1_2 High-Risk Drug (Is taking): Opioid (Dsch)
N0415H2_1 High-Drug Risk (Indication): Opioid (Adm)
N0415H2_2 High-Drug Risk (Indication): Opioid (Dsch)
N0415I1_1 High-Risk Drug (Is taking): Antiplatelet (Adm)
N0415I1_2 High-Risk Drug (Is taking): Antiplatelet (Dsch)
N0415I2_1 High-Risk Drug (Indication): Antiplatelet (Adm)
N0415I2_2 High-Risk Drug (Indication): Antiplatelet (Dsch)
N0415J1_1 High-Risk Drug (Is taking): Hypoglycemic (Adm)
N0415J1_2 High-Risk Drug (Is taking): Hypoglycemic (Dsch)
N0415J2_1 High-Risk Drug (Indication): Hypoglycemic (Adm)
N0415J2_2 High-Risk Drug (Indication): Hypoglycemic (Dsch)
N0415Z1_1 High-Risk Drug (Is taking): None of above (Adm)
N0415Z1_2 High-Risk Drug (Is taking): None of above (Dsch)
N2001 Drug Regimen Review
N2003 Medication Follow-up
N2005 Medication Intervention
O0110A1A Treatment: Chemotherapy (Admission)
O0110A1C Treatment: Chemotherapy (Discharge)
O0110A2A Treatment: Chemo - IV (Admission)
O0110A2C Treatment: Chemo - IV (Discharge)
O0110A3A Treatment: Chemo - Oral (Admission)
O0110A3C Treatment: Chemo - Oral (Discharge)
O0110A10A Treatment: Chemo - Other (Admission)
O0110A10C Treatment: Chemo - Other (Discharge)
O0110B1A Treatment: Radiation (Admission)
O0110B1C Treatment: Radiation (Discharge)
O0110C1A Therapies: Oxygen Therapy (Admission)
O0110C1C Therapies: Oxygen Therapy (Discharge)
O0110C2A Therapies: Oxygen - Continuous (Admission)
O0110C2C Therapies: Oxygen - Continuous (Discharge)
O0110C3A Therapies: Oxygen - Intermittent (Admission)
O0110C3C Therapies: Oxygen - Intermittent (Discharge)
O0110C4A Therapies: Oxygen - High-concentration (Admission)
O0110C4C Therapies: Oxygen - High-concentration (Discharge)
O0110D1A Therapies: Suctioning (Admission)
O0110D1C Therapies: Suctioning (Discharge)
O0110D2A Therapies: Suctioning - Scheduled (Admission)
O0110D2C Therapies: Suctioning - Scheduled (Discharge)
O0110D3A Therapies: Suctioning - As Needed (Admission)
O0110D3C Therapies: Suctioning - 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: IV - Vasoactive medications (Admission)
O0110H2C Other: IV - Vasoactive medications (Discharge)
O0110H3A Other: IV - Antibiotics (Admission)
O0110H3C Other: IV - Antibiotics (Discharge)
O0110H4A Other: IV - Anticoagulation (Admission)
O0110H4C Other: IV - Anticoagulation (Discharge)
O0110H10A Other: IV - Other (Admission)
O0110H10C Other: IV - 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: IV Access - Peripheral (Admission)
O0110O2C Other: IV Access - Peripheral (Discharge)
O0110O3A Other: IV Access - Midline (Admission)
O0110O3C Other: IV Access - Midline (Discharge)
O0110O4A Other: IV Access - Central (Admission)
O0110O4C Other: IV Access - Central (Discharge)
O0110Z1A Other: None of the above (Admission)
O0110Z1C Other: None of the above (Discharge)
O0350 COVID-19 Vaccination Up To Date

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Generated: 06/05/2024 02:10:29 PM