-1009
Property | Specification |
Data System | LTCH |
Data Specs | V4.00.1 |
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 |
[V4.00.0]-Removed mappings to the following deleted items: A1000A, A1000B, A1000C, A1000D, A1000E, A1000F, A1100A, A1802, A2110, C1610A, C1610B, C1610C, C1610D, C1610E1, C1610E2, I5602, O0100G, O0100H, O0100H2A, O0100J, O0100N, O0100Z, O0250A-C. Added mappings to the following new items: A1005A-X, A1010A-X, A1110B, A1805, A2105, A1990, A1250A-X, A2121, A2122A-E, A2123, A2124A-E, B0200, B1000, B1300, C0100, C0200, C0300A, C0300B, C0300C, C0400A, C0400B, C0400C, C1310A, C1310B, C1310C, C1310D, D0150A1, D0150A2, D0150B1, D0150B2, D0150C1, D0150C2, D0150D1, D0150D2, D0150E1, D0150E2, D0150F1, D0150F2, D0150G1, D0150G2, D0150H1, D0150H2, D0150I1, D0150I2, D0700, GG0170G1, GG0170G2, GG0170G3, GG0170L1, GG0170L2, GG0170L3, GG0170M1, GG0170M2, GG0170M3, GG0170N1, GG0170N2, GG0170N3, GG0170O1, GG0170O2, GG0170O3, GG0170P1, GG0170P2, GG0170P3, J0510, J0520, J0530, K0520A1, K0520A4, K0520A5, K0520B1, K0520B4, K0520B5, K0520C1, K0520C4, K0520C5, K0520D1, K0520D4, K0520D5, K0520Z1, K0520Z4, K0520Z5, N0415A1, N0415A2, N0415E1, N0415E2, N0415F1, N0415F2, N0415H1, N0415H2, N0415I1, N0415I2, N0415J1, N0415J2, N0415Z1, O0110A1A, O0110A2A, O0110A3A, O0110A10A, O0110B1A, O0110A1C, O0110A2C, O0110A3C, O0110A10C, O0110B1C, O0110C1A, O0110C2A, O0110C3A, O0110C4A, O0110D1A, O0110D2A, O0110D3A, O0110E1A, O0110G1A, O0110G2A, O0110G3A, O0110H1A, O0110H2A, O0110H3A, O0110H4A, O0110H10A, O0110I1A, O0110J1A, O0110J2A, O0110J3A, O0110O1A, O0110O2A, O0110O3A, O0110O4A, O0110O1C, O0110O2C, O0110O3C, O0110O4C, O0110Z1A, O0110C1C, O0110C2C, O0110C3C, O0110C4C, O0110D1C, O0110D2C, O0110D3C, O0110E1C, O0110F1C, O0110G1C, O0110G2C, O0110G3C, O0110H1C, O0110H2C, O0110H3C, O0110H4C, O0110H10C, O0110I1C, O0110J1C, O0110J2C, O0110J3C, O0110Z1C, O0150A2. [V4.00.1]-Added mappings to new items A1005Y, A1010Y, A1010Z, A1250Y. |
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 |
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 sitting 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 |
GG0170G1 | Func Mobil (Adm Perf) - Car Transfer |
GG0170G2 | Func Mobil (Dschg Goal) - Car Transfer |
GG0170G3 | Mobil Perf (Dischrg Perf) - Car Transfer |
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 |
GG0170L1 | Func Mobil (Adm Perf) - Walking 10ft uneven surf |
GG0170L2 | Func Mobil (Dschg Goal) - Walk 10ft uneven surf |
GG0170L3 | Func Mobil (Dschg Perf) - Walk 10ft uneven surf |
GG0170M1 | Func Mobil (Adm Perf) - 1 step (curb) |
GG0170M2 | Func Mobil (Dschg Goal) - 1 step (crub) |
GG0170M3 | Func Mobil (Dschg Perf) - 1 step (curb) |
GG0170N1 | Func Mobil (Adm Perf) - 4 steps |
GG0170N2 | Func Mobil (Dschg Goal) - 4 steps |
GG0170N3 | Func Mobil (Dschg Perf) - 4 steps |
GG0170O1 | Func Mobil (Adm Perf) - 12 steps |
GG0170O2 | Func Mobil (Dschg Goal) - 12 steps |
GG0170O3 | Func Mobil (Dschg Perf) - 12 steps |
GG0170P1 | Func Mobil (Adm Perf) - Picking up an object |
GG0170P2 | Func Mobil (Dschg Goal) - 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 |
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 or scooter used |
GG0170RR3 | Indicate the type of wheelchair or 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 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-Drug Risk (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 |
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Generated: 03/21/2022 09:57:13 AM