-1009


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Property Specification
Data System LTCH
Data Specs V2.01.0
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

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
A1000A Ethnicity: American Indian or Alaska Native
A1000B Ethnicity: Asian
A1000C Ethnicity: Black or African American
A1000D Ethnicity: Hispanic or Latino
A1000E Ethnicity: Native Hawaiian/Pacific Islander
A1000F Ethnicity: White
A1100A Does the patient need or want an interpreter
A1200 Marital status
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 payor source
A1400X Payer: Unknown
A1400Y Payer: Other
A1802 Admitted from
A2110 Discharge location
A2500 Were there program interruption(s) during stay
B0100 Comatose
BB0700 Expression of Ideas and Wants (3-day asmt period)
BB0800 Understanding Verbal Content (3-day asmt period)
C1610A Acute onset
C1610B Fluctuating Course
C1610C Inattention
C1610D Disorganized Thinking
C1610E1 Altered Consc Lvl - Alert
C1610E2 Altered Consc Lvl - Vigilant/Lethargic/Stupor/Coma
GG0100B Indoor Mobility (Ambulation)
GG0110A Manual wheelchair
GG0110B Motorized wheelchair or scooter
GG0110C Mechanical lift
GG0110Z None of the above
GG0130A1 Self-Care (Adm Perf) - Eating
GG0130A2 Self-Care (Dschg Goal) - Eating
GG0130A3 Self-Care (Dschg Perf) - Eating
GG0130B1 Self-Care (Adm Perf) - Oral hygiene
GG0130B2 Self-Care (Dschg Goal) - Oral hygiene
GG0130B3 Self-Care (Dschg Perf) - Oral hygiene
GG0130C1 Self-Care (Adm Perf) - Toileting hygiene
GG0130C2 Self-Care (Dschg Goal) - Toileting hygiene
GG0130C3 Self-Care (Dschg Perf) - Toileting hygiene
GG0130D1 Self-Care (Adm Perf) - Wash upper body
GG0130D2 Self-Care (Dschg Goal) - Wash upper body
GG0130D3 Self-Care (Dschg Perf) - Wash upper body
GG0170A1 Func Mobil (Adm Perf) - Roll left and right
GG0170A2 Func Mobil (Dschg Goal) - Roll left and right
GG0170A3 Func Mobil (Dschg Perf) - Roll left and right
GG0170B1 Func Mobil (Adm Perf) - Sit to lying
GG0170B2 Func Mobil (Dschg Goal) - Sit to lying
GG0170B3 Func Mobil (Dschg Perf) - Sit to lying
GG0170C1 Func Mobil (Adm Perf) - Lying to sit on side
GG0170C2 Func Mobil (Dschg Goal) - Lying to sitting on side
GG0170C3 Func Mobil (Dschg Perf) - Lying to sitting on side
GG0170D1 Func Mobil (Adm Perf) - Sit to stand
GG0170D2 Func Mobil (Dschg Goal) - Sit to stand
GG0170D3 Func Mobil (Dschg Perf) - Sit to stand
GG0170E1 Func Mobil (Adm Perf) - Chair/bed-to-chair trans
GG0170E2 Func Mobil (Dschg Goal) - Chair/bed-to-chair trans
GG0170E3 Func Mobil (Dschg Perf) - Chair/bed-to-chair trans
GG0170F1 Func Mobil (Adm Perf) - Toilet transfer
GG0170F2 Func Mobil (Dschg Goal) - Toilet transfer
GG0170F3 Func Mobil (Dschg Perf) - Toilet transfer
GG0170H1 Does the patient walk
GG0170H3 Does the patient walk
GG0170I1 Func Mobil (Adm Perf) - Walk 10 feet
GG0170I2 Func Mobil (Dschg Goal) - Walk 10 feet
GG0170I3 Func Mobil (Dschg Perf) - Walk 10 feet
GG0170J1 Func Mobil (Adm Perf) - Walk 50 feet w/2 turns
GG0170J2 Func Mobil (Dschg Goal) - 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
GG0170K2 Func Mobil (Dschg Goal) - Walk 150 feet
GG0170K3 Func Mobil (Dschg Perf) - Walk 150 feet
GG0170Q1 Does the patient use a wheelchair/scooter
GG0170Q3 Does the patient use a wheelchair/scooter
GG0170R1 Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns
GG0170R2 Func Mobil (Dschg Goal) - Wheel 50 feet w/2 turns
GG0170R3 Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns
GG0170RR1 Indicate the type of wheelchair/scooter used
GG0170RR3 Indicate the type of wheelchair/scooter used
GG0170S1 Func Mobil (Adm Perf) - Wheel 150 feet
GG0170S2 Func Mobil (Dschg Goal) - Wheel 150 feet
GG0170S3 Func Mobil (Dschg Perf) - Wheel 150 feet
GG0170SS1 Indicate the type of wheelchair/scooter used
GG0170SS3 Indicate the type of wheelchair/scooter used.
H0350 Bladder continence
H0400 Bowel continence
I0050 Patient primary medical condition
I0101 Severe and Metastatic Cancers
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
I5460 Locked-In State
I5470 Severe Anoxic Brain Damage, Cerebral Edema
I5601 Malnutrition
I5602 At Risk for Malnutrition
I7900 None of the Above
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
M0210 Patient has Stage 1 or higher pressure ulcers
O0100F3 Invasive Mechanical Ventilator - weaning
O0100F4 Invasive Mechanical Ventilator - non-weaning
O0100G Non-invasive ventilator (BIPAP, CPAP)
O0100J Dialysis
O0100N Total Parenteral Nutrition
O0100Z None of the above
O0250A Was influenza vaccine received
O0250C If influenza vaccine not received, state reason

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Generated: 04/21/2016 03:34:11 PM