Hospice Item Summary
Item |
Group |
Type |
Length |
Fixed Start-End |
Description |
ITM_SET_SYS_CD | Control | Code | 10 | 1-10 | Item set 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 |
CRCTN_NUM | Control | Number | 2 | 34-35 | Correction number |
STATE_CD | Control | Code | 2 | 36-37 | Provider"s state postal code |
FAC_ID | Control | Text | 16 | 38-53 | Assigned provider submission ID |
SFTWR_VNDR_ID | Control | Text | 9 | 54-62 | Software vendor federal employer tax ID |
SFTWR_VNDR_NAME | Control | Text | 30 | 63-92 | Software vendor company name |
SFTWR_VNDR_EMAIL_ADR | Control | Text | 50 | 93-142 | Software vendor email address |
SFTWR_PROD_NAME | Control | Text | 50 | 143-192 | Software product name |
SFTWR_PROD_VRSN_CD | Control | Text | 20 | 193-212 | Software product version code |
CONTROL_ITEMS_FILLER | Filler | Filler | 200 | 213-412 | Control items filler |
A0050 | Asmt | Code | 1 | 413-413 | 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) |
A0205 | Asmt | Code | 2 | 436-437 | Site of service at admission |
A0220 | Asmt | Date | 8 | 438-445 | Admission date |
A0245 | Asmt | Date | 8 | 446-453 | Date initial nursing assessment initiated |
A0250 | Asmt | Code | 2 | 454-455 | Reason for record |
A0270 | Asmt | Date | 8 | 456-463 | Discharge date |
A0500A | Asmt | Text | 12 | 464-475 | Patient first name |
A0500B | Asmt | Text | 1 | 476-476 | Patient middle initial |
A0500C | Asmt | Text | 18 | 477-494 | Patient last name |
A0500D | Asmt | Text | 3 | 495-497 | Patient name suffix |
A0550 | Asmt | Text | 11 | 676-686 | Patient zip code |
A0600A | Asmt | Text | 9 | 498-506 | Social Security Number |
A0600B | Asmt | Text | 12 | 507-518 | Patient Medicare/railroad insurance number |
A0700 | Asmt | Text | 14 | 519-532 | Patient Medicaid number |
A0800 | Asmt | Code | 1 | 533-533 | Gender |
A0900 | Asmt | Date | 8 | 534-541 | Birthdate |
A1000A | Asmt | Checklist | 1 | 542-542 | Ethnicity: American Indian or Alaska Native |
A1000B | Asmt | Checklist | 1 | 543-543 | Ethnicity: Asian |
A1000C | Asmt | Checklist | 1 | 544-544 | Ethnicity: Black or African American |
A1000D | Asmt | Checklist | 1 | 545-545 | Ethnicity: Hispanic or Latino |
A1000E | Asmt | Checklist | 1 | 546-546 | Ethnicity: Native Hawaiian/Pacific Islander |
A1000F | Asmt | Checklist | 1 | 547-547 | Ethnicity: White |
A1400A | Asmt | Checklist | 1 | 687-687 | Payor: Medicare (FFS) |
A1400B | Asmt | Checklist | 1 | 688-688 | Payor: Medicare (managed care/Part C/Mcr Advant.) |
A1400C | Asmt | Checklist | 1 | 689-689 | Payor: Medicaid (FFS) |
A1400D | Asmt | Checklist | 1 | 690-690 | Payor: Medicaid (managed care) |
A1400G | Asmt | Checklist | 1 | 691-691 | Payor: Other Government |
A1400H | Asmt | Checklist | 1 | 692-692 | Payor: Private insurance/Medigap |
A1400I | Asmt | Checklist | 1 | 693-693 | Payor: Private managed care |
A1400J | Asmt | Checklist | 1 | 694-694 | Payor: Self-pay |
A1400K | Asmt | Checklist | 1 | 695-695 | Payor: No payor source |
A1400X | Asmt | Checklist | 1 | 696-696 | Payor: Unknown |
A1400Y | Asmt | Checklist | 1 | 697-697 | Payor: Other |
A1802 | Asmt | Code | 2 | 548-549 | Admitted from |
A2115 | Asmt | Code | 2 | 550-551 | Reason for discharge |
F2000A | Asmt | Code | 1 | 552-552 | Was patient asked about CPR |
F2000B | Asmt | Date | 8 | 553-560 | Date asked about CPR |
F2100A | Asmt | Code | 1 | 561-561 | Was patient asked about treatments other than CPR |
F2100B | Asmt | Date | 8 | 562-569 | Date asked about treatment other than CPR |
F2200A | Asmt | Code | 1 | 570-570 | Was patient asked about hospitalization |
F2200B | Asmt | Date | 8 | 571-578 | Date asked about hospitalization |
F3000A | Asmt | Code | 1 | 579-579 | Was patient asked spiritual/existential concerns |
F3000B | Asmt | Date | 8 | 580-587 | Date asked about spiritual/existential concerns |
I0010 | Asmt | Code | 2 | 588-589 | Principal diagnosis |
J0900A | Asmt | Code | 1 | 590-590 | Was patient screened for pain |
J0900B | Asmt | Date | 8 | 591-598 | Date of first screening for pain |
J0900C | Asmt | Code | 1 | 599-599 | Patient"s pain severity was |
J0900D | Asmt | Code | 1 | 600-600 | Type of standardized pain tool used |
J0905 | Asmt | Code | 1 | 698-698 | Is pain an active problem for the patient? |
J0910A | Asmt | Code | 1 | 601-601 | Was comprehensive pain assessment done |
J0910B | Asmt | Date | 8 | 602-609 | Date of comprehensive pain assessment |
J0910C1 | Asmt | Code | 1 | 610-610 | Pain asmt included: location |
J0910C2 | Asmt | Code | 1 | 611-611 | Pain asmt included: severity |
J0910C3 | Asmt | Code | 1 | 612-612 | Pain asmt included: character |
J0910C4 | Asmt | Code | 1 | 613-613 | Pain asmt included: duration |
J0910C5 | Asmt | Code | 1 | 614-614 | Pain asmt included: frequency |
J0910C6 | Asmt | Code | 1 | 615-615 | Pain asmt included: what relieves/worsens |
J0910C7 | Asmt | Code | 1 | 616-616 | Pain asmt included: effect function/quality life |
J0910C9 | Asmt | Code | 1 | 617-617 | Pain asmt included: none of the above |
J2030A | Asmt | Code | 1 | 618-618 | Was patient screened for shortness of breath |
J2030B | Asmt | Date | 8 | 619-626 | Date of first screening for shortness of breath |
J2030C | Asmt | Code | 1 | 627-627 | Did screening indicate pt had shortness of breath |
J2040A | Asmt | Code | 1 | 628-628 | Was treatment for shortness of breath initiated |
J2040B | Asmt | Date | 8 | 629-636 | Date treatment for shortness of breath initiated |
J2040C1 | Asmt | Checklist | 1 | 637-637 | Type(s) treat for shortness of breath: opioids |
J2040C2 | Asmt | Checklist | 1 | 638-638 | Type(s) treat for shortness of breath: other med |
J2040C3 | Asmt | Checklist | 1 | 639-639 | Type(s) treat for shortness of breath: oxygen |
J2040C4 | Asmt | Checklist | 1 | 640-640 | Type(s) treat for shortness of breath: non-med |
N0500A | Asmt | Code | 1 | 641-641 | Was scheduled opioid initiated or continued |
N0500B | Asmt | Date | 8 | 642-649 | Date scheduled opioid initiated or continued |
N0510A | Asmt | Code | 1 | 650-650 | Was PRN opioid initiated or continued |
N0510B | Asmt | Date | 8 | 651-658 | Date PRN opioid initiated or continued |
N0520A | Asmt | Code | 1 | 659-659 | Was bowel regimen initiated or continued |
N0520B | Asmt | Date | 8 | 660-667 | Date bowel regimen initiated or continued |
ITEM_FILLER_001 | Filler | Filler | 1 | 699-699 | Item filler: replaces old O5000 |
ITEM_FILLER_002 | Filler | Filler | 1 | 700-700 | Item filler: replaces old O5010A1 |
ITEM_FILLER_003 | Filler | Filler | 1 | 701-701 | Item filler: replaces old O5010A2 |
ITEM_FILLER_004 | Filler | Filler | 1 | 702-702 | Item filler: replaces old O5010A3 |
ITEM_FILLER_005 | Filler | Filler | 1 | 703-703 | Item filler: replaces old O5010B1 |
ITEM_FILLER_006 | Filler | Filler | 1 | 704-704 | Item filler: replaces old O5010B2 |
ITEM_FILLER_007 | Filler | Filler | 1 | 705-705 | Item filler: replaces old O5010B3 |
ITEM_FILLER_008 | Filler | Filler | 1 | 706-706 | Item filler: replaces old O5010C1 |
ITEM_FILLER_009 | Filler | Filler | 1 | 707-707 | Item filler: replaces old O5010C2 |
ITEM_FILLER_010 | Filler | Filler | 1 | 708-708 | Item filler: replaces old O5010C3 |
ITEM_FILLER_011 | Filler | Filler | 1 | 709-709 | Item filler: replaces old O5010D1 |
ITEM_FILLER_012 | Filler | Filler | 1 | 710-710 | Item filler: replaces old O5010D2 |
ITEM_FILLER_013 | Filler | Filler | 1 | 711-711 | Item filler: replaces old O5010D3 |
ITEM_FILLER_014 | Filler | Filler | 1 | 712-712 | Item filler: replaces old O5010E1 |
ITEM_FILLER_015 | Filler | Filler | 1 | 713-713 | Item filler: replaces old O5010E2 |
ITEM_FILLER_016 | Filler | Filler | 1 | 714-714 | Item filler: replaces old O5010E3 |
ITEM_FILLER_017 | Filler | Filler | 1 | 715-715 | Item filler: replaces old O5010F1 |
ITEM_FILLER_018 | Filler | Filler | 1 | 716-716 | Item filler: replaces old O5010F2 |
ITEM_FILLER_019 | Filler | Filler | 1 | 717-717 | Item filler: replaces old O5010F3 |
ITEM_FILLER_020 | Filler | Filler | 1 | 718-718 | Item filler: replaces old O5020 |
ITEM_FILLER_021 | Filler | Filler | 1 | 719-719 | Item filler: replaces old O5030A1 |
ITEM_FILLER_022 | Filler | Filler | 1 | 720-720 | Item filler: replaces old O5030A2 |
ITEM_FILLER_023 | Filler | Filler | 1 | 721-721 | Item filler: replaces old O5030A3 |
ITEM_FILLER_024 | Filler | Filler | 1 | 722-722 | Item filler: replaces old O5030A4 |
ITEM_FILLER_025 | Filler | Filler | 1 | 723-723 | Item filler: replaces old O5030B1 |
ITEM_FILLER_026 | Filler | Filler | 1 | 724-724 | Item filler: replaces old O5030B2 |
ITEM_FILLER_027 | Filler | Filler | 1 | 725-725 | Item filler: replaces old O5030B3 |
ITEM_FILLER_028 | Filler | Filler | 1 | 726-726 | Item filler: replaces old O5030B4 |
ITEM_FILLER_029 | Filler | Filler | 1 | 727-727 | Item filler: replaces old O5030C1 |
ITEM_FILLER_030 | Filler | Filler | 1 | 728-728 | Item filler: replaces old O5030C2 |
ITEM_FILLER_031 | Filler | Filler | 1 | 729-729 | Item filler: replaces old O5030C3 |
ITEM_FILLER_032 | Filler | Filler | 1 | 730-730 | Item filler: replaces old O5030C4 |
ITEM_FILLER_033 | Filler | Filler | 1 | 731-731 | Item filler: replaces old O5030D1 |
ITEM_FILLER_034 | Filler | Filler | 1 | 732-732 | Item filler: replaces old O5030D2 |
ITEM_FILLER_035 | Filler | Filler | 1 | 733-733 | Item filler: replaces old O5030D3 |
ITEM_FILLER_036 | Filler | Filler | 1 | 734-734 | Item filler: replaces old O5030D4 |
ITEM_FILLER_037 | Filler | Filler | 1 | 735-735 | Item filler: replaces old O5030E1 |
ITEM_FILLER_038 | Filler | Filler | 1 | 736-736 | Item filler: replaces old O5030E2 |
ITEM_FILLER_039 | Filler | Filler | 1 | 737-737 | Item filler: replaces old O5030E3 |
ITEM_FILLER_040 | Filler | Filler | 1 | 738-738 | Item filler: replaces old O5030E4 |
ITEM_FILLER_041 | Filler | Filler | 1 | 739-739 | Item filler: replaces old O5030F1 |
ITEM_FILLER_042 | Filler | Filler | 1 | 740-740 | Item filler: replaces old O5030F2 |
ITEM_FILLER_043 | Filler | Filler | 1 | 741-741 | Item filler: replaces old O5030F3 |
ITEM_FILLER_044 | Filler | Filler | 1 | 742-742 | Item filler: replaces old O5030F4 |
Z0500B | Asmt | Date | 8 | 668-675 | Date of signature verifying record completion |
ASMT_ITEMS_FILLER | Filler | Filler | 933 | 743-1675 | Assessment items filler |
ASSESSMENT_ID | Calc | Number | 15 | 1676-1690 | Assessment internal ID |
ORIGINAL_ASSESSMENT_ID | Calc | Number | 15 | 1691-1705 | Original assessment ID |
RESIDENT_INTERNAL_ID | Calc | Number | 10 | 1706-1715 | Resident internal ID |
TARGET_DATE | Calc | Date | 8 | 1716-1723 | Target date |
PROVIDER_INTERNAL_ID | Calc | Number | 10 | 1724-1733 | Provider internal ID |
SUBMISSION_ID | Calc | Number | 15 | 1734-1748 | Submission ID |
SUBMISSION_DATE | Calc | Date | 8 | 1749-1756 | Submission date |
SUBMISSION_COMPLETE_DATE | Calc | Date | 8 | 1757-1764 | Submission processing completion date |
SUBMITTING_USER_ID | Calc | Text | 30 | 1765-1794 | Submitter user ID |
RESIDENT_MATCH_CRITERIA | Calc | Number | 2 | 1795-1796 | Resident matching criteria |
RESIDENT_AGE | Calc | Number | 3 | 1797-1799 | Age of resident on the target date |
BIRTHDATE_SUBMIT_CODE | Calc | Code | 1 | 1800-1800 | Birth date submit code |
C_CCN_NUM | Calc | Text | 12 | 1801-1812 | Calculated Facility CMS Certification Number (CCN) |
C_HICN_MBI_IND | Calc | Text | 1 | 1813-1813 | Calculated HICN MBI Indicator |
C_SSNRI_TRNSLTN_HICN_TXT | Calc | Text | 12 | 1814-1825 | SSNRI Translation HICN Text |
C_SSNRI_TRNSLTN_MBI_TXT | Calc | Text | 12 | 1826-1837 | SSNRI Translation MBI Text |
CALCULATED_ITEMS_FILLER | Filler | Filler | 463 | 1838-2300 | Calculated items filler |
DATA_END_INDICATOR | Calc | Code | 1 | 2301-2301 | End of data terminator code |
CR | Calc | Code | 1 | 2302-2302 | Carriage return (ASCII 013) |
LF | Calc | Code | 1 | 2303-2303 | Line feed character (ASCII 010) |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 08/06/2020 09:24:06 AM