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
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
A0055 Asmt Number 2 412-413 Correction number
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 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
A1050 Asmt Code 1 562-562 Highest education completed
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
A1300D Asmt Text 23 580-602 Lifetime occupation(s)
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
A1800 Asmt Code 2 616-617 Admitted from
A1810A Asmt Checklist 1 618-618 Last 2 mo: Short-stay acute hospital (IPPS)
A1810B Asmt Checklist 1 619-619 Last 2 mo: Community residential setting
A1810C Asmt Checklist 1 620-620 Last 2 mo: Long-term care facility (LTC)
A1810D Asmt Checklist 1 621-621 Last 2 mo: Skilled nursing facility (SNF)
A1810E Asmt Checklist 1 622-622 Last 2 mo: Hospital emergency department
A1810F Asmt Checklist 1 623-623 Last 2 mo: Long-term care hospital (LTCH)
A1810G Asmt Checklist 1 624-624 Last 2 mo: Inpatient rehabilitation fac/unit(IRF)
A1810H Asmt Checklist 1 625-625 Last 2 mo: Home health agency (HHA)
A1810I Asmt Checklist 1 626-626 Last 2 mo: Hospice
A1810J Asmt Checklist 1 627-627 Last 2 mo: Outpatient services
A1810K Asmt Checklist 1 628-628 Last 2 mo: Psychiatric hospital or unit
A1810L Asmt Checklist 1 629-629 Last 2 mo: ID/DD facility
A1810Z Asmt Checklist 1 630-630 Last 2 mo: None of the above
A1820 Asmt ICD 8 631-638 Previous medical setting primary diagnosis
A1955 Asmt Code 1 639-639 Discharge delay
A1960 Asmt Code 2 640-641 Reason for discharge delay
A1970 Asmt Code 1 642-642 Discharge return status
A2100 Asmt Code 2 643-644 Discharge location
B0100 Asmt Code 1 645-645 Comatose
GG0160A Asmt Code 2 646-647 Functional Mobil: Roll left and right
GG0160B Asmt Code 2 648-649 Functional Mobil: Sit to lying
GG0160C Asmt Code 2 650-651 Functional Mobil: Lying to sitting on side of bed
H0400 Asmt Code 1 652-652 Bowel continence
I0900 Asmt Checklist 1 653-653 Peripheral vascular disease (PVD) or PAD
I2900 Asmt Checklist 1 654-654 Diabetes mellitus (DM)
I5600 Asmt Checklist 1 655-655 Malnutrition (protein, calorie), risk of malnutrit
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
M0300B3 Asmt Date 8 665-672 Stage 2 pressure ulcers: date of oldest
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
M0610A Asmt Number 4 683-686 Stage 3 or 4 pressure ulcer length
M0610B Asmt Number 4 687-690 Stage 3 or 4 pressure ulcer width
M0610C Asmt Number 4 691-694 Stage 3 or 4 pressure ulcer depth
M0700 Asmt Code 1 695-695 Most severe tissue type for any pressure ulcer
M0800A Asmt Number 1 696-696 Worsened since prior asmt: Stage 2 pressure ulcers
M0800B Asmt Number 1 697-697 Worsened since prior asmt: Stage 3 pressure ulcers
M0800C Asmt Number 1 698-698 Worsened since prior asmt: Stage 4 pressure ulcers
Z0500B Asmt Date 8 699-706 Date assessment signed as complete
ASMT_ITEMS_FILLER Filler Text 1000 707-1706 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
CALCULATED_ITEMS_FILLER Filler Text 437 1832-2268 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: 07/12/2012 12:51:39 PM