-1009
Property | Specification |
Data System | LTCH |
Data Specs | V4.02.1 |
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 | [V4.02.0]-Removed mappings to deleted items GG0130A2, GG0130B2, GG0130C2, GG0130D2, GG0170A2, GG0170B2, GG0170C2, GG0170D2, GG0170E2, GG0170F2, GG0170G2, GG0170I2, GG0170J2, GG0170K2, GG0170L2, GG0170M2, GG0170N2, GG0170O2, GG0170P2, GG0170R2, GG0170S2, GG0130D1, GG0130D3. Added mapping to new item O0350. |
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 |
A1005A | Ethnicity: No, not Hispanic, Latino/a, Spanish |
A1005B | Ethnicity: Yes, Mex, Mex Amer, Chicano/a |
A1005C | Ethnicity: Yes, Puerto Rican |
A1005D | Ethnicity: Yes, Cuban |
A1005E | Ethnicity: Yes, another Hispanic/Latino/Spanish |
A1005X | Ethnicity: Patient unable to respond |
A1005Y | Ethnicity: Patient declines to respond |
A1010A | Race: White |
A1010B | Race: Black or African American |
A1010C | Race: American Indian or Alaska Native |
A1010D | Race: Asian Indian |
A1010E | Race: Chinese |
A1010F | Race: Filipino |
A1010G | Race: Japanese |
A1010H | Race: Korean |
A1010I | Race: Vietnamese |
A1010J | Race: Other Asian |
A1010K | Race: Native Hawaiian |
A1010L | Race: Guamanian or Chamorro |
A1010M | Race: Samoan |
A1010N | Race: Other Pacific Islander |
A1010X | Race: Patient unable to respond |
A1010Y | Race: Patient declines to respond |
A1010Z | Race: None of the above |
A1110B | Does the patient need or want an interpreter |
A1200 | Marital status |
A1250A | Transportation: Yes, medical |
A1250B | Transportation: Yes, non-medical |
A1250C | Transportation: No |
A1250X | Transportation: Patient unable to respond |
A1250Y | Transportation: Patient declines to respond |
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 payer source |
A1400X | Payer: Unknown |
A1400Y | Payer: Other |
A1805 | Admitted from |
A1990 | Discharged against medical advice |
A2105 | Discharge location |
A2121 | Current Reconciled Medication List - Provider |
A2122A | Provider Trans - Electronic Health Record |
A2122B | Provider Trans - Health Info Exchange |
A2122C | Provider Trans - Verbal |
A2122D | Provider Trans - Paper-based |
A2122E | Provider Trans - Other Methods |
A2123 | Current Reconciled Medication List - Ptnt/Fam/Care |
A2124A | Patient Trans - Electronic Health Record |
A2124B | Patient Trans - Health Info Exchange |
A2124C | Patient Trans - Verbal |
A2124D | Patient Trans - Paper-based |
A2124E | Patient Trans - Other Methods |
B0100 | Comatose |
B0200 | Hearing |
B1000 | Vision |
B1300 | Health Literacy |
BB0700 | Expression of Ideas and Wants (3-day asmt period) |
BB0800 | Understand Verbal/Non-Verbal Content (3-day asmt) |
C0100 | Brief Interview for Mental Status |
C0200 | Repetition of three words |
C0300A | Temporal Orientation: Able to report correct year |
C0300B | Temporal Orientation: Able to report correct month |
C0300C | Temporal Orientation: Able to report correct day |
C0400A | Recall: Able to recall "sock" |
C0400B | Recall: Able to recall "blue" |
C0400C | Recall: Able to recall "bed" |
C1310A | Delirium: Acute Onset Mental Status Change |
C1310B | Delirium: Inattention |
C1310C | Delirium: Disorganized thinking |
C1310D | Delirium: Altered level of consciousness |
D0150A1 | Mood: Little interest/pleasure doing things: Pres |
D0150A2 | Mood: Little interest/pleasure doing things: Freq |
D0150B1 | Mood: Feeling down, depressed, or hopeless: Pres |
D0150B2 | Mood: Feeling down, depressed, or hopeless: Freq |
D0150C1 | Mood: Trouble falling or staying asleep: Pres |
D0150C2 | Mood: Trouble falling or staying asleep: Freq |
D0150D1 | Mood: Feeling tired or having little energy: Pres |
D0150D2 | Mood: Feeling tired or having little energy: Freq |
D0150E1 | Mood: Poor appetite or overeating: Pres |
D0150E2 | Mood: Poor appetite or overeating: Freq |
D0150F1 | Mood: Feeling bad about yourself: Pres |
D0150F2 | Mood: Feeling bad about yourself: Freq |
D0150G1 | Mood: Trouble concentrating on things: Pres |
D0150G2 | Mood: Trouble concentrating on things: Freq |
D0150H1 | Mood: Moving or speaking so slowly: Pres |
D0150H2 | Mood: Moving or speaking so slowly: Freq |
D0150I1 | Mood: Thoughts of better off dead: Pres |
D0150I2 | Mood: Thoughts of better off dead: Freq |
D0700 | Social Isolation |
GG0100B | Indoor Mobility (Ambulation) |
GG0110A | Manual wheelchair |
GG0110B | Motorized wheelchair and/or scooter |
GG0110C | Mechanical lift |
GG0110Z | None of the above |
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 |
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 sitting 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 (Dischrg 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) - Walking 10ft uneven surf |
GG0170L3 | Func Mobil (Dschg Perf) - Walk 10ft 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 an object |
GG0170P3 | Func Mobil (Dschg Perf) - Picking up an object |
GG0170Q1 | Does the patient use a wheelchair and/or scooter |
GG0170Q3 | Does the patient use a wheelchair and/or scooter |
GG0170R1 | Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns |
GG0170R3 | Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns |
GG0170RR1 | Indicate the type of wheelchair or scooter used |
GG0170RR3 | Indicate the type of wheelchair or scooter used |
GG0170S1 | Func Mobil (Adm Perf) - Wheel 150 feet |
GG0170S3 | Func Mobil (Dschg Perf) - Wheel 150 feet |
GG0170SS1 | Indicate the type of wheelchair or scooter used |
GG0170SS3 | Indicate the type of wheelchair or scooter used. |
H0350 | Bladder continence |
H0400 | Bowel continence |
I0050 | Patient primary medical condition |
I0103 | Metastatic Cancer |
I0104 | Severe Cancer |
I0605 | Severe Left Systolic/Ventricular Dysfunction |
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 |
I5455 | Other Progressive Neuromuscular Disease |
I5460 | Locked-In State |
I5470 | Severe Anoxic Brain Damage, Cerebral Edema |
I5480 | Other Severe Neurological Injury-Disease-Dysfunc |
I5601 | Malnutrition |
I7100 | Lung Transplant |
I7101 | Heart Transplant |
I7102 | Liver Transplant |
I7103 | Kidney Transplant |
I7104 | Bone Marrow Transplant |
I7900 | None of the Above |
J0510 | Pain Effect on Sleep |
J0520 | Pain Interference with Therapy Activities |
J0530 | Pain Interference with Day-to-Day Activities |
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 |
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 |
M0210 | Patient has 1+ unhealed pressure ulcers/injuries |
N0415A1 | High-Risk Drug (Is Taking): Antipsychotic |
N0415A2 | High-Risk Drug (Indication) : Antipsychotic |
N0415E1 | High-Risk Drug (Is taking): Anticoagulant |
N0415E2 | High-Risk Drug (Indication): Anticoagulant |
N0415F1 | High-Risk Drug (Is taking): Antibiotic |
N0415F2 | High-Risk Drug (Indication): Antibiotic |
N0415H1 | High-Risk Drug (Is taking): Opioid |
N0415H2 | High-Risk Drug (Indication): Opioid |
N0415I1 | High-Risk Drug (Is taking): Antiplatelet |
N0415I2 | High-Risk Drug (Indication): Antiplatelet |
N0415J1 | High-Risk Drug (Is taking): Hypoglycemic |
N0415J2 | High-Risk Drug (Indication): Hypoglycemic |
N0415Z1 | 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: 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) |
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) |
O0150A | SBT: Invasive Mechanical Ventilation Support |
O0150A2 | SBT: Ventilator Weaning Status |
O0150B | SBT: Assessed for readiness by day 2 |
O0150C | SBT: Deemed medically ready by day 2 |
O0150D | SBT: Documentation of reason(s) - patient unready |
O0150E | SBT: Performed by day 2 |
O0200A | Invasive Mechanical Ventilator - Liberation Status |
O0350 | COVID-19 Vaccination Up To Date |
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Generated: 06/05/2024 03:40:40 PM