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
A0055 Control Number 2 412-413 Correction number
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
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 Medicaid 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
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
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
A1802 Asmt Code 2 768-769 Admitted from
A2110 Asmt Code 2 770-771 Discharge location
A2500 Asmt Code 1 707-707 Were there program interruption(s) during stay
A2510 Asmt Number 2 708-709 Number of program interruptions during stay
A2525A1 Asmt Date 8 925-932 First Interruption Start Date
A2525A2 Asmt Date 8 933-940 First Interruption End Date
A2525B1 Asmt Date 8 941-948 Second Interruption Start Date
A2525B2 Asmt Date 8 949-956 Second Interruption End Date
A2525C1 Asmt Date 8 957-964 Third Interruption Start Date
A2525C2 Asmt Date 8 965-972 Third Interruption End Date
A2525D1 Asmt Date 8 973-980 Fourth Interruption Start Date
A2525D2 Asmt Date 8 981-988 Fourth Interruption End Date
A2525E1 Asmt Date 8 989-996 Fifth Interruption Start Date
A2525E2 Asmt Date 8 997-1004 Fifth Interruption End Date
B0100 Asmt Code 1 645-645 Comatose
BB0700 Asmt Code 1 772-772 Expression of Ideas and Wants (3-day asmt period)
BB0800 Asmt Code 1 773-773 Understanding Verbal Content (3-day asmt period)
C1610A Asmt Code 1 774-774 Acute onset
C1610B Asmt Code 1 775-775 Fluctuating Course
C1610C Asmt Code 1 776-776 Inattention
C1610D Asmt Code 1 777-777 Disorganized Thinking
C1610E1 Asmt Code 1 778-778 Altered Consc Lvl - Alert
C1610E2 Asmt Code 1 779-779 Altered Consc Lvl - Vigilant/Lethargic/Stupor/Coma
GG0100B Asmt Code 1 780-780 Indoor Mobility (Ambulation)
GG0110A Asmt Checklist 1 781-781 Manual wheelchair
GG0110B Asmt Checklist 1 782-782 Motorized wheelchair or scooter
GG0110C Asmt Checklist 1 783-783 Mechanical lift
GG0110Z Asmt Checklist 1 784-784 None of the above
GG0130A1 Asmt Code 2 785-786 Self-Care (Adm Perf) - Eating
GG0130A2 Asmt Code 2 787-788 Self-Care (Dschg Goal) - Eating
GG0130A3 Asmt Code 2 789-790 Self-Care (Dschg Perf) - Eating
GG0130B1 Asmt Code 2 791-792 Self-Care (Adm Perf) - Oral hygiene
GG0130B2 Asmt Code 2 793-794 Self-Care (Dschg Goal) - Oral hygiene
GG0130B3 Asmt Code 2 795-796 Self-Care (Dschg Perf) - Oral hygiene
GG0130C1 Asmt Code 2 797-798 Self-Care (Adm Perf) - Toileting hygiene
GG0130C2 Asmt Code 2 799-800 Self-Care (Dschg Goal) - Toileting hygiene
GG0130C3 Asmt Code 2 801-802 Self-Care (Dschg Perf) - Toileting hygiene
GG0130D1 Asmt Code 2 803-804 Self-Care (Adm Perf) - Wash upper body
GG0130D2 Asmt Code 2 805-806 Self-Care (Dschg Goal) - Wash upper body
GG0130D3 Asmt Code 2 807-808 Self-Care (Dschg Perf) - Wash upper body
GG0170A1 Asmt Code 2 809-810 Func Mobil (Adm Perf) - Roll left and right
GG0170A2 Asmt Code 2 811-812 Func Mobil (Dschg Goal) - Roll left and right
GG0170A3 Asmt Code 2 813-814 Func Mobil (Dschg Perf) - Roll left and right
GG0170B1 Asmt Code 2 815-816 Func Mobil (Adm Perf) - Sit to lying
GG0170B2 Asmt Code 2 817-818 Func Mobil (Dschg Goal) - Sit to lying
GG0170B3 Asmt Code 2 819-820 Func Mobil (Dschg Perf) - Sit to lying
GG0170C1 Asmt Code 2 821-822 Func Mobil (Adm Perf) - Lying to sit on side
GG0170C2 Asmt Code 2 823-824 Func Mobil (Dschg Goal) - Lying to sitting on side
GG0170C3 Asmt Code 2 825-826 Func Mobil (Dschg Perf) - Lying to sitting on side
GG0170D1 Asmt Code 2 827-828 Func Mobil (Adm Perf) - Sit to stand
GG0170D2 Asmt Code 2 829-830 Func Mobil (Dschg Goal) - Sit to stand
GG0170D3 Asmt Code 2 831-832 Func Mobil (Dschg Perf) - Sit to stand
GG0170E1 Asmt Code 2 833-834 Func Mobil (Adm Perf) - Chair/bed-to-chair trans
GG0170E2 Asmt Code 2 835-836 Func Mobil (Dschg Goal) - Chair/bed-to-chair trans
GG0170E3 Asmt Code 2 837-838 Func Mobil (Dschg Perf) - Chair/bed-to-chair trans
GG0170F1 Asmt Code 2 839-840 Func Mobil (Adm Perf) - Toilet transfer
GG0170F2 Asmt Code 2 841-842 Func Mobil (Dschg Goal) - Toilet transfer
GG0170F3 Asmt Code 2 843-844 Func Mobil (Dschg Perf) - Toilet transfer
GG0170H1 Asmt Code 1 845-845 Does the patient walk
GG0170H3 Asmt Code 1 846-846 Does the patient walk
GG0170I1 Asmt Code 2 847-848 Func Mobil (Adm Perf) - Walk 10 feet
GG0170I2 Asmt Code 2 849-850 Func Mobil (Dschg Goal) - Walk 10 feet
GG0170I3 Asmt Code 2 851-852 Func Mobil (Dschg Perf) - Walk 10 feet
GG0170J1 Asmt Code 2 853-854 Func Mobil (Adm Perf) - Walk 50 feet w/2 turns
GG0170J2 Asmt Code 2 855-856 Func Mobil (Dschg Goal) - Walk 50 feet w/2 turns
GG0170J3 Asmt Code 2 857-858 Func Mobil (Dschg Perf) - Walk 50 feet w/2 turns
GG0170K1 Asmt Code 2 859-860 Func Mobil (Adm Perf) - Walk 150 feet
GG0170K2 Asmt Code 2 861-862 Func Mobil (Dschg Goal) - Walk 150 feet
GG0170K3 Asmt Code 2 863-864 Func Mobil (Dschg Perf) - Walk 150 feet
GG0170Q1 Asmt Code 1 865-865 Does the patient use a wheelchair/scooter
GG0170Q3 Asmt Code 1 866-866 Does the patient use a wheelchair/scooter
GG0170R1 Asmt Code 2 867-868 Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns
GG0170R2 Asmt Code 2 869-870 Func Mobil (Dschg Goal) - Wheel 50 feet w/2 turns
GG0170R3 Asmt Code 2 871-872 Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns
GG0170RR1 Asmt Code 1 873-873 Indicate the type of wheelchair/scooter used
GG0170RR3 Asmt Code 1 874-874 Indicate the type of wheelchair/scooter used
GG0170S1 Asmt Code 2 875-876 Func Mobil (Adm Perf) - Wheel 150 feet
GG0170S2 Asmt Code 2 877-878 Func Mobil (Dschg Goal) - Wheel 150 feet
GG0170S3 Asmt Code 2 879-880 Func Mobil (Dschg Perf) - Wheel 150 feet
GG0170SS1 Asmt Code 1 881-881 Indicate the type of wheelchair/scooter used
GG0170SS3 Asmt Code 1 882-882 Indicate the type of wheelchair/scooter used.
H0350 Asmt Code 1 883-883 Bladder continence
H0400 Asmt Code 1 652-652 Bowel continence
I0050 Asmt Code 1 884-884 Patient primary medical condition
I0050A Asmt ICD 8 885-892 Other medical condition - ICD code
I0101 Asmt Checklist 1 893-893 Severe and Metastatic Cancers
I0900 Asmt Checklist 1 653-653 Peripheral vascular disease (PVD) or PAD
I1501 Asmt Checklist 1 894-894 Chronic Kidney Disease, Stage 5
I1502 Asmt Checklist 1 895-895 Acute Renal Failure
I2101 Asmt Checklist 1 896-896 Septicemia, Sepsis, Systemic Inflammatory Response
I2600 Asmt Checklist 1 897-897 CNS Infect, Oppor Infect, Bone/Joint/Muscle Infect
I2900 Asmt Checklist 1 654-654 Diabetes mellitus (DM)
I4100 Asmt Checklist 1 898-898 Major Lower Limb Amputation
I4501 Asmt Checklist 1 899-899 Stroke
I4801 Asmt Checklist 1 900-900 Dementia
I4900 Asmt Checklist 1 901-901 Hemiplegia or Hemiparesis
I5000 Asmt Checklist 1 902-902 Paraplegia
I5101 Asmt Checklist 1 903-903 Complete Tetraplegia
I5102 Asmt Checklist 1 904-904 Incomplete Tetraplegia
I5110 Asmt Checklist 1 905-905 Other Spinal Cord Disorder/Injury
I5200 Asmt Checklist 1 906-906 Multiple Sclerosis (MS)
I5250 Asmt Checklist 1 907-907 Huntington"s Disease
I5300 Asmt Checklist 1 908-908 Parkinson"s Disease
I5450 Asmt Checklist 1 909-909 Amyotrophic Lateral Sclerosis
I5460 Asmt Checklist 1 910-910 Locked-In State
I5470 Asmt Checklist 1 911-911 Severe Anoxic Brain Damage, Cerebral Edema
I5601 Asmt Checklist 1 912-912 Malnutrition
I5602 Asmt Checklist 1 913-913 At Risk for Malnutrition
I7900 Asmt Checklist 1 914-914 None of the Above
J1800 Asmt Code 1 915-915 Any Falls Since Admission
J1900A Asmt Code 1 916-916 Num Falls Since Admission - No injury
J1900B Asmt Code 1 917-917 Num Falls Since Admission - Injury (except major)
J1900C Asmt Code 1 918-918 Num Falls Since Admission - Major injury
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
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
M0800A Asmt Number 1 696-696 Worsened: Stage 2 pressure ulcers
M0800B Asmt Number 1 697-697 Worsened: Stage 3 pressure ulcers
M0800C Asmt Number 1 698-698 Worsened: Stage 4 pressure ulcers
M0800D Asmt Number 1 1005-1005 Worsened: Unstageable - Non-removable dressing
M0800E Asmt Number 1 1006-1006 Worsened: Unstageable - Slough and/or eschar
M0800F Asmt Number 1 1007-1007 Worsened: Unstageable - Deep tissue injury
O0100F3 Asmt Checklist 1 919-919 Invasive Mechanical Ventilator - weaning
O0100F4 Asmt Checklist 1 920-920 Invasive Mechanical Ventilator - non-weaning
O0100G Asmt Checklist 1 921-921 Non-invasive ventilator (BIPAP, CPAP)
O0100J Asmt Checklist 1 922-922 Dialysis
O0100N Asmt Checklist 1 923-923 Total Parenteral Nutrition
O0100Z Asmt Checklist 1 924-924 None of the above
O0250A Asmt Code 1 758-758 Was influenza vaccine received
O0250B Asmt Date 8 759-766 Date influenza vaccine received
O0250C Asmt Code 1 767-767 If influenza vaccine not received, state reason
Z0500B Asmt Date 8 699-706 Date assessment signed as complete
ITEM_FILLER_001 Filler Text 1 562-562 Item filler: replaces old A1050
ITEM_FILLER_002 Filler Text 23 580-602 Item filler: replaces old A1300D
ITEM_FILLER_003 Filler Text 1 618-618 Item filler: replaces old A1810A
ITEM_FILLER_004 Filler Text 1 619-619 Item filler: replaces old A1810B
ITEM_FILLER_005 Filler Text 1 620-620 Item filler: replaces old A1810C
ITEM_FILLER_006 Filler Text 1 621-621 Item filler: replaces old A1810D
ITEM_FILLER_007 Filler Text 1 622-622 Item filler: replaces old A1810E
ITEM_FILLER_008 Filler Text 1 623-623 Item filler: replaces old A1810F
ITEM_FILLER_009 Filler Text 1 624-624 Item filler: replaces old A1810G
ITEM_FILLER_010 Filler Text 1 625-625 Item filler: replaces old A1810H
ITEM_FILLER_011 Filler Text 1 626-626 Item filler: replaces old A1810I
ITEM_FILLER_012 Filler Text 1 627-627 Item filler: replaces old A1810J
ITEM_FILLER_013 Filler Text 1 628-628 Item filler: replaces old A1810K
ITEM_FILLER_014 Filler Text 1 629-629 Item filler: replaces old A1810L
ITEM_FILLER_015 Filler Text 1 630-630 Item filler: replaces old A1810Z
ITEM_FILLER_016 Filler Text 8 631-638 Item filler: replaces old A1820
ITEM_FILLER_017 Filler Text 1 639-639 Item filler: replaces old A1955
ITEM_FILLER_018 Filler Text 2 640-641 Item filler: replaces old A1960
ITEM_FILLER_019 Filler Text 1 642-642 Item filler: replaces old A1970
ITEM_FILLER_020 Filler Text 8 665-672 Item filler: replaces old M0300B3
ITEM_FILLER_021 Filler Text 4 683-686 Item filler: replaces old M0610A
ITEM_FILLER_022 Filler Text 4 687-690 Item filler: replaces old M0610B
ITEM_FILLER_023 Filler Text 4 691-694 Item filler: replaces old M0610C
ITEM_FILLER_024 Filler Text 1 695-695 Item filler: replaces old M0700
ITEM_FILLER_025 Filler Text 2 616-617 Item filler: replaces old A1800
ITEM_FILLER_026 Filler Text 2 643-644 Item filler: replaces old A2100
ITEM_FILLER_027 Filler Text 2 646-647 Item filler: replaces old GG0160A
ITEM_FILLER_028 Filler Text 2 648-649 Item filler: replaces old GG0160B
ITEM_FILLER_029 Filler Text 2 650-651 Item filler: replaces old GG0160C
ITEM_FILLER_030 Filler Text 1 655-655 Item filler: replaces old I5600
ITEM_FILLER_031 Asmt Text 8 710-717 Item filler: replaces old A2520A1
ITEM_FILLER_032 Asmt Text 8 718-725 Item filler: replaces old A2520A2
ITEM_FILLER_033 Asmt Text 8 726-733 Item filler: replaces old A2520B1
ITEM_FILLER_034 Asmt Text 8 734-741 Item filler: replaces old A2520B2
ITEM_FILLER_035 Asmt Text 8 742-749 Item filler: replaces old A2520C1
ITEM_FILLER_036 Asmt Text 8 750-757 Item filler: replaces old A2520C2
ASMT_ITEMS_FILLER Filler Text 699 1008-1706 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
C_CCN_NUM Calc Text 12 1832-1843 Calculated Facility Certification Number (CCN)
CALCULATED_ITEMS_FILLER Filler Text 425 1844-2268 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: 04/21/2016 03:34:11 PM