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 |
A1005A | Asmt | Checklist | 1 | 1029-1029 | No, not of Hispanic, Latino/a, or Spanish origin |
A1005B | Asmt | Checklist | 1 | 1030-1030 | Yes, Mexican, Mexican American, Chicano/ |
A1005C | Asmt | Checklist | 1 | 1031-1031 | Yes, Puerto Rican |
A1005D | Asmt | Checklist | 1 | 1032-1032 | Yes, Cuban |
A1005E | Asmt | Checklist | 1 | 1033-1033 | Yes, another Hispanic, Latino, or Spanish origin |
A1005X | Asmt | Checklist | 1 | 1034-1034 | Patient unable to respond |
A1010A | Asmt | Checklist | 1 | 1035-1035 | Race: White |
A1010B | Asmt | Checklist | 1 | 1036-1036 | Race: Black or African American |
A1010C | Asmt | Checklist | 1 | 1037-1037 | Race: American Indian or Alaska Native |
A1010D | Asmt | Checklist | 1 | 1038-1038 | Race: Asian Indian |
A1010E | Asmt | Checklist | 1 | 1039-1039 | Race: Chinese |
A1010F | Asmt | Checklist | 1 | 1040-1040 | Race: Filipino |
A1010G | Asmt | Checklist | 1 | 1041-1041 | Race: Japanese |
A1010H | Asmt | Checklist | 1 | 1042-1042 | Race: Korean |
A1010I | Asmt | Checklist | 1 | 1043-1043 | Race: Vietnamese |
A1010J | Asmt | Checklist | 1 | 1044-1044 | Race: Other Asian |
A1010K | Asmt | Checklist | 1 | 1045-1045 | Race: Native Hawaiian |
A1010L | Asmt | Checklist | 1 | 1046-1046 | Race: Guamanian or Chamorro |
A1010M | Asmt | Checklist | 1 | 1047-1047 | Race: Samoan |
A1010N | Asmt | Checklist | 1 | 1048-1048 | Race: Other Pacific Islander |
A1010X | Asmt | Checklist | 1 | 1049-1049 | Race: Patient unable to respond |
A1110A | Asmt | Text | 15 | 1050-1064 | Preferred language |
A1110B | Asmt | Code | 1 | 1065-1065 | Do you need or want an interpreter |
A1200 | Asmt | Code | 1 | 579-579 | Marital status |
A1250A | Asmt | Checklist | 1 | 1066-1066 | Transportation: Yes, medical |
A1250B | Asmt | Checklist | 1 | 1067-1067 | Transportation: Yes, non-medical |
A1250C | Asmt | Checklist | 1 | 1068-1068 | Transportation: No |
A1250X | Asmt | Checklist | 1 | 1069-1069 | Transportation: Patient unable to respond |
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 payer source |
A1400X | Asmt | Checklist | 1 | 614-614 | Payer: Unknown |
A1400Y | Asmt | Checklist | 1 | 615-615 | Payer: Other |
A1805 | Asmt | Code | 2 | 1070-1071 | Admitted from |
A1990 | Asmt | Code | 1 | 1072-1072 | Discharged against medical advice |
A2105 | Asmt | Code | 2 | 1073-1074 | Discharge location |
A2121 | Asmt | Code | 1 | 1075-1075 | Provision Current Reconciled Medication List |
A2122A | Asmt | Checklist | 1 | 1076-1076 | Electronic Health Record |
A2122B | Asmt | Checklist | 1 | 1077-1077 | Health Information Exchange Organization |
A2122C | Asmt | Checklist | 1 | 1078-1078 | Verbal |
A2122D | Asmt | Checklist | 1 | 1079-1079 | Paper-based |
A2122E | Asmt | Checklist | 1 | 1080-1080 | Other Methods |
A2123 | Asmt | Code | 1 | 1081-1081 | Provision Current Reconciled Medication |
A2124A | Asmt | Checklist | 1 | 1082-1082 | Electronic Health Record |
A2124B | Asmt | Checklist | 1 | 1083-1083 | Health Information Exchange Organization |
A2124C | Asmt | Checklist | 1 | 1084-1084 | Verbal |
A2124D | Asmt | Checklist | 1 | 1085-1085 | Paper-based |
A2124E | Asmt | Checklist | 1 | 1086-1086 | Other Methods |
B0100 | Asmt | Code | 1 | 645-645 | Comatose |
B0200 | Asmt | Code | 1 | 1087-1087 | Hearing |
B1000 | Asmt | Code | 1 | 1088-1088 | Vision |
B1300 | Asmt | Code | 1 | 1089-1089 | Health Literacy |
BB0700 | Asmt | Code | 1 | 772-772 | Expression of Ideas and Wants (3-day asmt period) |
BB0800 | Asmt | Code | 1 | 773-773 | Understand Verbal/Non-Verbal Content (3-day asmt) |
C0100 | Asmt | Code | 1 | 1090-1090 | Brief Interview for Mental Status |
C0200 | Asmt | Code | 1 | 1091-1091 | Repetition of three words |
C0300A | Asmt | Code | 1 | 1092-1092 | Able to report correct year |
C0300B | Asmt | Code | 1 | 1093-1093 | Able to report correct month |
C0300C | Asmt | Code | 1 | 1094-1094 | Able to report correct day of the week |
C0400A | Asmt | Code | 1 | 1095-1095 | Able to recall "sock" |
C0400B | Asmt | Code | 1 | 1096-1096 | Able to recall "blue" |
C0400C | Asmt | Code | 1 | 1097-1097 | Able to recall "bed" |
C0500 | Asmt | Number | 2 | 1098-1099 | BIMS Summary Score |
C1310A | Asmt | Code | 1 | 1100-1100 | Acute Onset Mental Status Change |
C1310B | Asmt | Code | 1 | 1101-1101 | Inattention |
C1310C | Asmt | Code | 1 | 1102-1102 | Disorganized thinking |
C1310D | Asmt | Code | 1 | 1103-1103 | Altered level of consciousness |
D0150A1 | Asmt | Code | 1 | 1104-1104 | Little interest or pleasure in doing things: Pres |
D0150A2 | Asmt | Code | 1 | 1105-1105 | Little interest or pleasure in doing things: Freq |
D0150B1 | Asmt | Code | 1 | 1106-1106 | Feeling down, depressed, or hopeless: Pres |
D0150B2 | Asmt | Code | 1 | 1107-1107 | Feeling down, depressed, or hopeless: Freq |
D0150C1 | Asmt | Code | 1 | 1108-1108 | Trouble falling or staying asleep: Pres |
D0150C2 | Asmt | Code | 1 | 1109-1109 | Trouble falling or staying asleep: Freq |
D0150D1 | Asmt | Code | 1 | 1110-1110 | Feeling tired or having little energy: Pres |
D0150D2 | Asmt | Code | 1 | 1111-1111 | Feeling tired or having little energy: Freq |
D0150E1 | Asmt | Code | 1 | 1112-1112 | Poor appetite or overeating: Pres |
D0150E2 | Asmt | Code | 1 | 1113-1113 | Poor appetite or overeating: Freq |
D0150F1 | Asmt | Code | 1 | 1114-1114 | Feeling bad about yourself: Pres |
D0150F2 | Asmt | Code | 1 | 1115-1115 | Feeling bad about yourself: Freq |
D0150G1 | Asmt | Code | 1 | 1116-1116 | Trouble concentrating on things: Pres |
D0150G2 | Asmt | Code | 1 | 1117-1117 | Trouble concentrating on things: Freq |
D0150H1 | Asmt | Code | 1 | 1118-1118 | Moving or speaking so slowly: Pres |
D0150H2 | Asmt | Code | 1 | 1119-1119 | Moving or speaking so slowly: Freq |
D0150I1 | Asmt | Code | 1 | 1120-1120 | Thoughts that you would be better off dead: Pres |
D0150I2 | Asmt | Code | 1 | 1121-1121 | Thoughts that you would be better off dead: Freq |
D0160 | Asmt | Number | 2 | 1122-1123 | Total severity score |
D0700 | Asmt | Code | 1 | 1124-1124 | Social Isolation |
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 and/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 sitting 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 |
GG0170G1 | Asmt | Code | 2 | 1125-1126 | Func Mobil (Adm Perf) - Car Transfer |
GG0170G2 | Asmt | Code | 2 | 1127-1128 | Func Mobil (Dschg Goal) - Car Transfer |
GG0170G3 | Asmt | Code | 2 | 1129-1130 | Mobil Perf (Dischrg Perf) - Car Transfer |
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 |
GG0170L1 | Asmt | Code | 2 | 1131-1132 | Func Mobil (Adm Perf) - Walking 10ft uneven surf |
GG0170L2 | Asmt | Code | 2 | 1133-1134 | Func Mobil (Dschg Goal) - Walk 10ft uneven surf |
GG0170L3 | Asmt | Code | 2 | 1135-1136 | Func Mobil (Dschg Perf) - Walk 10ft uneven surf |
GG0170M1 | Asmt | Code | 2 | 1137-1138 | Func Mobil (Adm Perf) - 1 step (curb) |
GG0170M2 | Asmt | Code | 2 | 1139-1140 | Func Mobil (Dschg Goal) - 1 step (crub) |
GG0170M3 | Asmt | Code | 2 | 1141-1142 | Func Mobil (Dschg Perf) - 1 step (curb) |
GG0170N1 | Asmt | Code | 2 | 1143-1144 | Func Mobil (Adm Perf) - 4 steps |
GG0170N2 | Asmt | Code | 2 | 1145-1146 | Func Mobil (Dschg Goal) - 4 steps |
GG0170N3 | Asmt | Code | 2 | 1147-1148 | Func Mobil (Dschg Perf) - 4 steps |
GG0170O1 | Asmt | Code | 2 | 1149-1150 | Func Mobil (Adm Perf) - 12 steps |
GG0170O2 | Asmt | Code | 2 | 1151-1152 | Func Mobil (Dschg Goal) - 12 steps |
GG0170O3 | Asmt | Code | 2 | 1153-1154 | Func Mobil (Dschg Perf) - 12 steps |
GG0170P1 | Asmt | Code | 2 | 1155-1156 | Func Mobil (Adm Perf) - Picking up an object |
GG0170P2 | Asmt | Code | 2 | 1157-1158 | Func Mobil (Dschg Goal) - Picking up an object |
GG0170P3 | Asmt | Code | 2 | 1159-1160 | Func Mobil (Dschg Perf) - Picking up an object |
GG0170Q1 | Asmt | Code | 1 | 865-865 | Does the patient use a wheelchair and/or scooter |
GG0170Q3 | Asmt | Code | 1 | 866-866 | Does the patient use a wheelchair and/or 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 or scooter used |
GG0170RR3 | Asmt | Code | 1 | 874-874 | Indicate the type of wheelchair or 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 or scooter used |
GG0170SS3 | Asmt | Code | 1 | 882-882 | Indicate the type of wheelchair or 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 |
I0103 | Asmt | Checklist | 1 | 1008-1008 | Metastatic Cancer |
I0104 | Asmt | Checklist | 1 | 1009-1009 | Severe Cancer |
I0605 | Asmt | Checklist | 1 | 1010-1010 | Severe Left Systolic/Ventricular Dysfunction |
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 |
I5455 | Asmt | Checklist | 1 | 1011-1011 | Other Progressive Neuromuscular Disease |
I5460 | Asmt | Checklist | 1 | 910-910 | Locked-In State |
I5470 | Asmt | Checklist | 1 | 911-911 | Severe Anoxic Brain Damage, Cerebral Edema |
I5480 | Asmt | Checklist | 1 | 1012-1012 | Other Severe Neurological Injury-Disease-Dysfunc |
I5601 | Asmt | Checklist | 1 | 912-912 | Malnutrition |
I5602 | Asmt | Checklist | 1 | 913-913 | At Risk for Malnutrition |
I7100 | Asmt | Checklist | 1 | 1013-1013 | Lung Transplant |
I7101 | Asmt | Checklist | 1 | 1014-1014 | Heart Transplant |
I7102 | Asmt | Checklist | 1 | 1015-1015 | Liver Transplant |
I7103 | Asmt | Checklist | 1 | 1016-1016 | Kidney Transplant |
I7104 | Asmt | Checklist | 1 | 1017-1017 | Bone Marrow Transplant |
I7900 | Asmt | Checklist | 1 | 914-914 | None of the Above |
J0510 | Asmt | Code | 1 | 1161-1161 | Pain effect on sleep |
J0520 | Asmt | Code | 1 | 1162-1162 | Pain interference with therapy activities |
J0530 | Asmt | Code | 1 | 1163-1163 | Pain interference with day-to-day activities |
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) |
K0520A1 | Asmt | Checklist | 1 | 1164-1164 | Nutritional approach (Admission): Parenteral |
K0520A4 | Asmt | Checklist | 1 | 1165-1165 | Nutritional approaches (7 days): Parenteral |
K0520A5 | Asmt | Checklist | 1 | 1166-1166 | Nutritional approaches (discharge): Parenteral |
K0520B1 | Asmt | Checklist | 1 | 1167-1167 | Nutritional approaches (admission): Feeding tube |
K0520B4 | Asmt | Checklist | 1 | 1168-1168 | Nutritional approaches (7 days): Feeding tube |
K0520B5 | Asmt | Checklist | 1 | 1169-1169 | Nutritional approaches (discharge): Feeding Tube |
K0520C1 | Asmt | Checklist | 1 | 1170-1170 | Nutritional approaches (admission) : Mechanically |
K0520C4 | Asmt | Checklist | 1 | 1171-1171 | Nutritional approaches (7 days): mech altered diet |
K0520C5 | Asmt | Checklist | 1 | 1172-1172 | Nutritional approaches (discharge): mech altered |
K0520D1 | Asmt | Checklist | 1 | 1173-1173 | Nutritional approaches (admission) : Therapeutic |
K0520D4 | Asmt | Checklist | 1 | 1174-1174 | Nutritional approaches (7 day): Therapeutic diet |
K0520D5 | Asmt | Checklist | 1 | 1175-1175 | Nutritional approaches (discharge): Therapeutic |
K0520Z1 | Asmt | Checklist | 1 | 1176-1176 | Nutritional approaches (admission) : None |
K0520Z4 | Asmt | Checklist | 1 | 1177-1177 | Nutritional approaches (7 days): None |
K0520Z5 | Asmt | Checklist | 1 | 1178-1178 | Nutritional approaches (discharge): None |
M0210 | Asmt | Code | 1 | 661-661 | Patient has 1+ unhealed pressure ulcers/injuries |
M0300A | Asmt | Number | 1 | 662-662 | Stage 1 pressure injuries: 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 due to dressing/device: number present |
M0300E2 | Asmt | Number | 1 | 678-678 | Unstageable due to dressing/device: number at adm |
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 as deep tissue: num present |
M0300G2 | Asmt | Number | 1 | 682-682 | Unstageable as deep tissue: num at adm |
N0415A1 | Asmt | Checklist | 1 | 1179-1179 | High-Risk Drug (Is Taking): Antipsychotic |
N0415A2 | Asmt | Checklist | 1 | 1180-1180 | High-Risk Drug (Indication) : Antipsychotic |
N0415E1 | Asmt | Checklist | 1 | 1181-1181 | High-Risk Drug (Is taking): Anticoagulant |
N0415E2 | Asmt | Checklist | 1 | 1182-1182 | High-Risk Drug (Indication): Anticoagulant |
N0415F1 | Asmt | Checklist | 1 | 1183-1183 | High-Risk Drug (Is taking): Antibiotic |
N0415F2 | Asmt | Checklist | 1 | 1184-1184 | High-Risk Drug (Indication): Antibiotic |
N0415H1 | Asmt | Checklist | 1 | 1185-1185 | High-Risk Drug (Is taking): Opioid |
N0415H2 | Asmt | Checklist | 1 | 1186-1186 | High-Drug Risk (Indication): Opioid |
N0415I1 | Asmt | Checklist | 1 | 1187-1187 | High-Risk Drug (Is taking): Antiplatelet |
N0415I2 | Asmt | Checklist | 1 | 1188-1188 | High-Risk Drug (Indication): Antiplatelet |
N0415J1 | Asmt | Checklist | 1 | 1189-1189 | High-Risk Drug (Is taking): Hypoglycemic |
N0415J2 | Asmt | Checklist | 1 | 1190-1190 | High-Risk Drug (Indication): Hypoglycemic |
N0415Z1 | Asmt | Checklist | 1 | 1191-1191 | High-Risk Drug (Is taking): None of the above |
N2001 | Asmt | Code | 1 | 1018-1018 | Drug Regimen Review |
N2003 | Asmt | Code | 1 | 1019-1019 | Medication Follow-up |
N2005 | Asmt | Code | 1 | 1020-1020 | Medication Intervention |
O0110A1a | Asmt | Checklist | 1 | 1192-1192 | Treatment: Chemotherapy (Admission) |
O0110A2a | Asmt | Checklist | 1 | 1193-1193 | Treatment: IV (Admission) |
O0110A3a | Asmt | Checklist | 1 | 1194-1194 | Treatment: Oral (Admission) |
O0110A10a | Asmt | Checklist | 1 | 1195-1195 | Treatment: Other (Admission) |
O0110B1a | Asmt | Checklist | 1 | 1196-1196 | Treatment: Radiation (Admission) |
O0110C1a | Asmt | Checklist | 1 | 1197-1197 | Therapies: Oxygen Therapy (Admission) |
O0110C2a | Asmt | Checklist | 1 | 1198-1198 | Therapies: Continuous (Admission) |
O0110C3a | Asmt | Checklist | 1 | 1199-1199 | Therapies: Intermittent (Admission) |
O0110C4a | Asmt | Checklist | 1 | 1200-1200 | Therapies: High-concentration (Admission) |
O0110D1a | Asmt | Checklist | 1 | 1201-1201 | Therapies: Suctioning (Admission) |
O0110D2a | Asmt | Checklist | 1 | 1202-1202 | Therapies: Scheduled |
O0110D3a | Asmt | Checklist | 1 | 1203-1203 | Therapies: As Needed (Admission) |
O0110E1a | Asmt | Checklist | 1 | 1204-1204 | Therapies: Tracheostomy Care (Admission) |
O0110G1a | Asmt | Checklist | 1 | 1205-1205 | Therapies: Non-Invas Mechanical Ventilator (Admis) |
O0110G2a | Asmt | Checklist | 1 | 1206-1206 | Therapies: BiPAP (Admission) |
O0110G3a | Asmt | Checklist | 1 | 1207-1207 | Therapies: CPAP (Admission) |
O0110H1a | Asmt | Checklist | 1 | 1208-1208 | Other: IV Medications (Admission) |
O0110H2a | Asmt | Checklist | 1 | 1209-1209 | Other: Vasoactive medications (Admission) |
O0110H3a | Asmt | Checklist | 1 | 1210-1210 | Other: Antibiotics (Admission) |
O0110H4a | Asmt | Checklist | 1 | 1211-1211 | Other: Anticoagulation (Admission) |
O0110H10a | Asmt | Checklist | 1 | 1212-1212 | Other: Other (Admission) |
O0110I1a | Asmt | Checklist | 1 | 1213-1213 | Other: Transfusions (Admission) |
O0110J1a | Asmt | Checklist | 1 | 1214-1214 | Other: Dialysis (Admission) |
O0110J2a | Asmt | Checklist | 1 | 1215-1215 | Other: Hemodialysis (Admission) |
O0110J3a | Asmt | Checklist | 1 | 1216-1216 | Other: Peritoneal dialysis (Admission) |
O0110O1a | Asmt | Checklist | 1 | 1217-1217 | Other: IV Access (Admission) |
O0110O2a | Asmt | Checklist | 1 | 1218-1218 | Other: Peripheral (Admission) |
O0110O3a | Asmt | Checklist | 1 | 1219-1219 | Other: Midline (Admission) |
O0110O4a | Asmt | Checklist | 1 | 1220-1220 | Other: Central (Admission) |
O0110Z1a | Asmt | Checklist | 1 | 1221-1221 | Other: None of the above (Admission) |
O0110A1c | Asmt | Checklist | 1 | 1222-1222 | Treatment: Chemotherapy (Discharge) |
O0110A2c | Asmt | Checklist | 1 | 1223-1223 | Treatment: IV (Discharge) |
O0110A3c | Asmt | Checklist | 1 | 1224-1224 | Treatment: Oral (Discharge) |
O0110A10c | Asmt | Checklist | 1 | 1225-1225 | Treatment: Other (Discharge) |
O0110B1c | Asmt | Checklist | 1 | 1226-1226 | Treatment: Radiation (Discharge) |
O0110C1c | Asmt | Checklist | 1 | 1227-1227 | Therapies: Oxygen Therapy (Discharge) |
O0110C2c | Asmt | Checklist | 1 | 1228-1228 | Therapies: Continuous (Discharge) |
O0110C3c | Asmt | Checklist | 1 | 1229-1229 | Therapies: Intermittent (Discharge) |
O0110C4c | Asmt | Checklist | 1 | 1230-1230 | Therapies: High-concentration (Discharge) |
O0110D1c | Asmt | Checklist | 1 | 1231-1231 | Therapies: Suctioning (Discharge) |
O0110D2c | Asmt | Checklist | 1 | 1232-1232 | Therapies: Scheduled (Discharge) |
O0110D3c | Asmt | Checklist | 1 | 1233-1233 | Therapies: As Needed (Discharge) |
O0110E1c | Asmt | Checklist | 1 | 1234-1234 | Therapies: Tracheostomy Care (Discharge) |
O0110G1c | Asmt | Checklist | 1 | 1235-1235 | Therapies: Non-Invas Mechanical Ventilator (Disch) |
O0110G2c | Asmt | Checklist | 1 | 1236-1236 | Therapies: BiPAP (Discharge) |
O0110G3c | Asmt | Checklist | 1 | 1237-1237 | Therapies: CPAP (Discharge) |
O0110F1c | Asmt | Checklist | 1 | 1238-1238 | Therapies: Invasive Mechanical Ventilator (Disch) |
O0110H1c | Asmt | Checklist | 1 | 1239-1239 | Other: IV Medications (Discharge) |
O0110H2c | Asmt | Checklist | 1 | 1240-1240 | Other: Vasoactive medications (Discharge) |
O0110H3c | Asmt | Checklist | 1 | 1241-1241 | Other: Antibiotics (Discharge) |
O0110H4c | Asmt | Checklist | 1 | 1242-1242 | Other: Anticoagulation (Discharge) |
O0110H10c | Asmt | Checklist | 1 | 1243-1243 | Other: Other (Discharge) |
O0110I1c | Asmt | Checklist | 1 | 1244-1244 | Other: Transfusions (Discharge) |
O0110J1c | Asmt | Checklist | 1 | 1245-1245 | Other: Dialysis (Discharge) |
O0110J2c | Asmt | Checklist | 1 | 1246-1246 | Other: Hemodialysis (Discharge) |
O0110J3c | Asmt | Checklist | 1 | 1247-1247 | Other: Peritoneal dialysis (Discharge) |
O0110O1c | Asmt | Checklist | 1 | 1248-1248 | Other: IV Access (Discharge) |
O0110O2c | Asmt | Checklist | 1 | 1249-1249 | Other: Peripheral (Discharge) |
O0110O3c | Asmt | Checklist | 1 | 1250-1250 | Other: Midline (Discharge) |
O0110O4c | Asmt | Checklist | 1 | 1251-1251 | Other: Central (Discharge) |
O0110Z1c | Asmt | Checklist | 1 | 1252-1252 | Other: None of the above (Discharge) |
O0150A | Asmt | Code | 1 | 1023-1023 | SBT: Invasive Mechanical Ventilation Support |
O0150A2 | Asmt | Code | 1 | 1253-1253 | SBT: Ventilator Weaning Status |
O0150B | Asmt | Code | 1 | 1024-1024 | SBT: Assessed for readiness by day 2 |
O0150C | Asmt | Code | 1 | 1025-1025 | SBT: Deemed medically ready by day 2 |
O0150D | Asmt | Code | 1 | 1026-1026 | SBT: Documentation of reason(s) - patient unready |
O0150E | Asmt | Code | 1 | 1027-1027 | SBT: Performed by day 2 |
O0200A | Asmt | Code | 1 | 1028-1028 | Invasive Mechanical Ventilator - Liberation Status |
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 | Filler | Text | 8 | 710-717 | Item filler: replaces old A2520A1 |
ITEM_FILLER_032 | Filler | Text | 8 | 718-725 | Item filler: replaces old A2520A2 |
ITEM_FILLER_033 | Filler | Text | 8 | 726-733 | Item filler: replaces old A2520B1 |
ITEM_FILLER_034 | Filler | Text | 8 | 734-741 | Item filler: replaces old A2520B2 |
ITEM_FILLER_035 | Filler | Text | 8 | 742-749 | Item filler: replaces old A2520C1 |
ITEM_FILLER_036 | Filler | Text | 8 | 750-757 | Item filler: replaces old A2520C2 |
ITEM_FILLER_037 | Filler | Text | 1 | 707-707 | Item filler: replaces old A2500 |
ITEM_FILLER_038 | Filler | Text | 2 | 708-709 | Item filler: replaces old A2510 |
ITEM_FILLER_039 | Filler | Text | 8 | 925-932 | Item filler: replaces old A2525A1 |
ITEM_FILLER_040 | Filler | Text | 8 | 933-940 | Item filler: replaces old A2525A2 |
ITEM_FILLER_041 | Filler | Text | 8 | 941-948 | Item filler: replaces old A2525B1 |
ITEM_FILLER_042 | Filler | Text | 8 | 949-956 | Item filler: replaces old A2525B2 |
ITEM_FILLER_043 | Filler | Text | 8 | 957-964 | Item filler: replaces old A2525C1 |
ITEM_FILLER_044 | Filler | Text | 8 | 965-972 | Item filler: replaces old A2525C2 |
ITEM_FILLER_045 | Filler | Text | 8 | 973-980 | Item filler: replaces old A2525D1 |
ITEM_FILLER_046 | Filler | Text | 8 | 981-988 | Item filler: replaces old A2525D2 |
ITEM_FILLER_047 | Filler | Text | 8 | 989-996 | Item filler: replaces old A2525E1 |
ITEM_FILLER_048 | Filler | Text | 8 | 997-1004 | Item filler: replaces old A2525E2 |
ITEM_FILLER_049 | Filler | Text | 1 | 845-845 | Item filler: replaces old GG0170H1 |
ITEM_FILLER_050 | Filler | Text | 1 | 846-846 | Item filler: replaces old GG0170H3 |
ITEM_FILLER_051 | Filler | Text | 1 | 696-696 | Item filler: replaces old M0800A |
ITEM_FILLER_052 | Filler | Text | 1 | 697-697 | Item filler: replaces old M0800B |
ITEM_FILLER_053 | Filler | Text | 1 | 698-698 | Item filler: replaces old M0800C |
ITEM_FILLER_054 | Filler | Text | 1 | 1005-1005 | Item filler: replaces old M0800D |
ITEM_FILLER_055 | Filler | Text | 1 | 1006-1006 | Item filler: replaces old M0800E |
ITEM_FILLER_056 | Filler | Text | 1 | 1007-1007 | Item filler: replaces old M0800F |
ITEM_FILLER_057 | Filler | Text | 1 | 919-919 | Item filler: replaces old O0100F3 |
ITEM_FILLER_058 | Filler | Text | 1 | 920-920 | Item filler: replaces old O0100F4 |
ITEM_FILLER_059 | Filler | Text | 1 | 893-893 | Item filler: replaces old I0101 |
ITEM_FILLER_060 | Filler | Text | 1 | 556-556 | Item filler: replaces old A1000A |
ITEM_FILLER_061 | Filler | Text | 1 | 557-557 | Item filler: replaces old A1000B |
ITEM_FILLER_062 | Filler | Text | 1 | 558-558 | Item filler: replaces old A1000C |
ITEM_FILLER_063 | Filler | Text | 1 | 559-559 | Item filler: replaces old A1000D |
ITEM_FILLER_064 | Filler | Text | 1 | 560-560 | Item filler: replaces old A1000E |
ITEM_FILLER_065 | Filler | Text | 1 | 561-561 | Item filler: replaces old A1000F |
ITEM_FILLER_066 | Filler | Text | 1 | 563-563 | Item filler: replaces old A1100A |
ITEM_FILLER_067 | Filler | Text | 15 | 564-578 | Item filler: replaces item A1100B |
ITEM_FILLER_068 | Filler | Text | 2 | 768-769 | Item Filler: replaces item A1802 |
ITEM_FILLER_069 | Filler | Text | 2 | 770-771 | Item filler: replaces old A2110 |
ITEM_FILLER_070 | Filler | Text | 1 | 774-774 | Item filler: replaces old C1610A |
ITEM_FILLER_071 | Filler | Text | 1 | 775-775 | Item filler: replaces old C1610B |
ITEM_FILLER_072 | Filler | Text | 1 | 776-776 | Item filler: replaces old C1610C |
ITEM_FILLER_073 | Filler | Text | 1 | 777-777 | Item filler: replaces old C1610D |
ITEM_FILLER_074 | Filler | Text | 1 | 778-778 | Item filler: replaces old C1610E1 |
ITEM_FILLER_075 | Filler | Text | 1 | 779-779 | Item filler: replaces old C1610E2 |
ITEM_FILLER_076 | Filler | Text | 1 | 921-921 | Item filler: replaces old O0100G |
ITEM_FILLER_077 | Filler | Text | 1 | 1021-1021 | Item filler: replaces old O0100H |
ITEM_FILLER_078 | Filler | Text | 1 | 1022-1022 | Item filler: replaces old O0100H2A |
ITEM_FILLER_079 | Filler | Text | 1 | 922-922 | Item filler: replaces old O0100J |
ITEM_FILLER_080 | Filler | Text | 1 | 923-923 | Item filler: replaces old O0100N |
ITEM_FILLER_081 | Filler | Text | 1 | 924-924 | Item filler: replaces old O0100Z |
ASMT_ITEMS_FILLER | Filler | Text | 404 | 1254-1931 | Assessment items filler |
ASSESSMENT_ID | Calc | Number | 15 | 1932-1946 | Assessment internal ID |
ORIGINAL_ASSESSMENT_ID | Calc | Number | 15 | 1947-1961 | Original assessment ID |
RESIDENT_INTERNAL_ID | Calc | Number | 10 | 1962-1971 | Patient internal ID |
TARGET_DATE | Calc | Date | 8 | 1972-1979 | Target date |
PROVIDER_INTERNAL_ID | Calc | Number | 10 | 1980-1989 | Provider internal ID |
SUBMISSION_ID | Calc | Number | 15 | 1990-2004 | Submission ID |
SUBMISSION_DATE | Calc | Date | 8 | 2005-2012 | Submission date |
SUBMISSION_COMPLETE_DATE | Calc | Date | 8 | 2013-2020 | Submission processing completion date |
SUBMITTING_USER_ID | Calc | Text | 30 | 2021-2050 | Submitter user ID |
RESIDENT_MATCH_CRITERIA | Calc | Number | 2 | 2051-2052 | Resident matching criteria |
RESIDENT_AGE | Calc | Number | 3 | 2053-2055 | Age of patient on the target date |
BIRTHDATE_SUBMIT_CODE | Calc | Code | 1 | 2056-2056 | Birth date submit code |
C_CCN_NUM | Calc | Text | 12 | 2057-2068 | Calculated Facility Certification Number (CCN) |
C_HICN_MBI_IND | Calc | Text | 1 | 2069-2069 | Calculated HICN MBI Indicator |
C_SSNRI_TRNSLTN_HICN_TXT | Calc | Text | 12 | 2070-2081 | SSNRI Translation HICN Text |
C_SSNRI_TRNSLTN_MBI_TXT | Calc | Text | 12 | 2082-2093 | SSNRI Translation MBI Text |
CALCULATED_ITEMS_FILLER | Filler | Text | 400 | 2094-2493 | Calculated items filler |
DATA_END_INDICATOR | Calc | Code | 1 | 2494-2494 | End of data terminator code |
CR | Calc | Code | 1 | 2495-2495 | Carriage return (ASCII 013) |
LF | Calc | Code | 1 | 2496-2496 | Line feed character (ASCII 010) |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 02/29/2020 10:39:12 PM