-3009


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Property Specification
Data System Hospice
Data Specs V3.00.0
Edit Type Format
Severity Fatal
Edit Text Values of Code and Checklist Items:
Only the coded values listed in the "Item Values" table of the Detailed Data Specifications Report may be submitted for this item.
Version Notes [V3.00.0]-Removed mappings to O5000 and O5020, since those items were deleted.

Item List
Item ID Description
ITM_SET_SYS_CD Item set system code
ITM_SBST_CD Item subset code
STATE_CD Provider"s state postal code
A0050 Type of record
A0205 Site of service at admission
A0250 Reason for record
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
A1400A Payor: Medicare (FFS)
A1400B Payor: Medicare (managed care/Part C/Mcr Advant.)
A1400C Payor: Medicaid (FFS)
A1400D Payor: Medicaid (managed care)
A1400G Payor: Other Government
A1400H Payor: Private insurance/Medigap
A1400I Payor: Private managed care
A1400J Payor: Self-pay
A1400K Payor: No payor source
A1400X Payor: Unknown
A1400Y Payor: Other
A1802 Admitted from
A2115 Reason for discharge
F2000A Was patient asked about CPR
F2100A Was patient asked about treatments other than CPR
F2200A Was patient asked about hospitalization
F3000A Was patient asked spiritual/existential concerns
I0010 Principal diagnosis
J0900A Was patient screened for pain
J0900C Patient"s pain severity was
J0900D Type of standardized pain tool used
J0905 Is pain an active problem for the patient?
J0910A Was comprehensive pain assessment done
J0910C1 Pain asmt included: location
J0910C2 Pain asmt included: severity
J0910C3 Pain asmt included: character
J0910C4 Pain asmt included: duration
J0910C5 Pain asmt included: frequency
J0910C6 Pain asmt included: what relieves/worsens
J0910C7 Pain asmt included: effect function/quality life
J0910C9 Pain asmt included: none of the above
J2030A Was patient screened for shortness of breath
J2030C Did screening indicate pt had shortness of breath
J2040A Was treatment for shortness of breath initiated
J2040C1 Type(s) treat for shortness of breath: opioids
J2040C2 Type(s) treat for shortness of breath: other med
J2040C3 Type(s) treat for shortness of breath: oxygen
J2040C4 Type(s) treat for shortness of breath: non-med
N0500A Was scheduled opioid initiated or continued
N0510A Was PRN opioid initiated or continued
N0520A Was bowel regimen initiated or continued

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Generated: 08/06/2020 09:24:06 AM