-5004

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Property | Specification
Data System

IRF-PAI
Data Specs V5.00.0 DRAFT
Edit Type Consistency
Severity Warning
Edit Text Entering a dash as a response to any Quality Measure item may result in a payment reduction of two percentage points for the applicable FY annual increase factor.
Version Notes [V5.00.0] - Mapped following new items:
A1110A, B0200, B1000, C0100, C0100_2, C0200, C0200_2, C0300A, C0300A_2, C0300B, C0300B_2, C0300C, C0300C_2, C0400A, C0400A_2, C0400B, C0400B_2, C0400C, C0400C_2, C0500, C0500_2, C1310A_1, C1310A_2, C1310B_1, C1310B_2, C1310C_1, C1310C_2, C1310D_1, C1310D_2, D0150A1_1, D0150A1_2, D0150A2_1, D0150A2_2, D0150B1_1, D0150B1_2, D0150B2_1, D0150B2_2, D0150C1_1, D0150C1_2, D0150C2_1, D0150C2_2, D0150D1_1, D0150D1_2, D0150D2_1, D0150D2_2, D0150E1_1, D0150E1_2, D0150E2_1, D0150E2_2, D0150F1_1, D0150F1_2, D0150F2_1, D0150F2_2, D0150G1_1, D0150G1_2, D0150G2_1, D0150G2_2, D0150H1_1, D0150H1_2, D0150H2_1, D0150H2_2, D0150I1_1, D0150I1_2, D0150I2_1, D0150I2_2, D0160_1, D0160_2, K0520A1, K0520A4, K0520A5, K0520B1, K0520B4, K0520B5, K0520C1, K0520C4, K0520C5, K0520D1, K0520D4, K0520D5, K0520Z1, K0520Z4, K0520Z5, N0415A1_1, N0415A1_2, N0415A2_1, N0415A2_2, N0415E1_1, N0415E1_2, N0415E2_1, N0415E2_2, N0415F1_1, N0415F1_2, N0415F2_1, N0415F2_2, N0415H1_1, N0415H1_2, N0415H2_1, N0415H2_2, N0415I1_1, N0415I1_2, N0415I2_1, N0415I2_2, N0415J1_1, N0415J1_2, N0415J2_1, N0415J2_2, N0415Z1_1, N0415Z1_2, O0110A1a, O0110A1c, O0110A2a, O0110A2c, O0110A3a, O0110A3c, O0110A10a, O0110A10c, O0110B1a, O0110B1c, O0110C1a, O0110C1c, O0110C2a, O0110C2c, O0110C3a, O0110C3c, O0110C4a, O0110C4c, O0110D1a, O0110D1c, O0110D2a, O0110D2c, O0110D3a, O0110D3c, O0110E1a, O0110E1c, O0110F1a, O0110F1c, O0110G1a, O0110G1c, O0110G2a, O0110G2c, O0110G3a, O0110G3c, O0110H1a, O0110H1c, O0110H2a, O0110H2c, O0110H3a, O0110H3c, O0110H4a, O0110H4c, O0110H10a, O0110H10c, O0110I1a, O0110I1c, O0110J1a, O0110J1c, O0110J2a, O0110J2c, O0110J3a, O0110J3c, O0110O1a, O0110O1c, O0110O2a, O0110O2c, O0110O3a, O0110O3c, O0110O4a, O0110O4c, O0110Z1a, O0110Z1c

Item List
Item ID | Description
25A | Height
26A | Weight
A1110A | Preferred language
B0200 | Hearing
B1000 | Vision
C0100 | Brief Interview - Mental Status (BIMS)
C0100_2 | Brief Interview - Mental Status (BIMS)
C0200 | BIMS - Repetition of Three Words
C0200_2 | BIMS - Repetition of Three Words
C0300A | BIMS - Temporal Orientation - Year
C0300A_2 | BIMS - Temporal Orientation - Year
C0300B | BIMS - Temporal Orientation - Month
C0300B_2 | BIMS - Temporal Orientation - Month
C0300C | BIMS - Temporal Orientation - Day
C0300C_2 | BIMS - Temporal Orientation - Day
C0400A | BIMS - Recalls Sock
C0400A_2 | BIMS - Recalls Sock
C0400B | BIMS - Recalls Blue
C0400B_2 | BIMS - Recalls Blue
C0400C | BIMS - Recalls Bed
C0400C_2 | BIMS - Recalls Bed
C0500 | BIMS - Summary Score
C0500_2 | BIMS - Summary Score
C1310A_1 | Acute Onset Mental Status Change
C1310A_2 | Acute Onset Mental Status Change
C1310B_1 | Inattention
C1310B_2 | Inattention
C1310C_1 | Disorganized thinking
C1310C_2 | Disorganized thinking
C1310D_1 | Altered level of consciousness
C1310D_2 | Altered level of consciousness
D0150A1_1 | Little interest or pleasure in doing things: Presc
D0150A2_1 | Little interest or pleasure in doing things: Freq
D0150A1_2 | Little interest or pleasure in doing things: Presc
D0150A2_2 | Little interest or pleasure in doing things: Freq
D0150B1_1 | Feeling down, depressed, or hopeless: Presc
D0150B2_1 | Feeling down, depressed, or hopeless: Freq
D0150B1_2 | Feeling down, depressed, or hopeless: Presc
D0150B2_2 | Feeling down, depressed, or hopeless: Freq
D0150C1_1 | Trouble falling or staying asleep: Presc
D0150C2_1 | Trouble falling or staying asleep: Freq
D0150C1_2 | Trouble falling or staying asleep: Presc
D0150C2_2 | Trouble falling or staying asleep: Freq
D0150D1_1 | Feeling tired or having little energy: Presc
D0150D2_1 | Feeling tired or having little energy: Freq
D0150D1_2 | Feeling tired or having little energy: Presc
D0150D2_2 | Feeling tired or having little energy: Freq
D0150E1_1 | Poor appetite or overeating: Presc
D0150E2_1 | Poor appetite or overeating: Freq
D0150E1_2 | Poor appetite or overeating: Presc
D0150E2_2 | Poor appetite or overeating: Freq
D0150F1_1 | Feeling bad about yourself: Presc
D0150F2_1 | Feeling bad about yourself: Freq
D0150F1_2 | Feeling bad about yourself: Presc
D0150F2_2 | Feeling bad about yourself: Freq
D0150G1_1 | Trouble concentrating on things: Presc
D0150G2_1 | Trouble concentrating on things: Freq
D0150G1_2 | Trouble concentrating on things: Presc
D0150G2_2 | Trouble concentrating on things: Freq
D0150H1_1 | Moving or speaking so slowly: Presc
D0150H2_1 | Moving or speaking so slowly: Freq
D0150H1_2 | Moving or speaking so slowly: Presc
D0150H2_2 | Moving or speaking so slowly: Freq
D0150I1_1 | Thoughts that you would be better off dead: Presc
D0150I2_1 | Thoughts that you would be better off dead: Freq
D0150I1_2 | Thoughts that you would be better off dead: Presc
D0150I2_2 | Thoughts that you would be better off dead: Freq
D0160_1 | Total Severity Score
D0160_2 | Total Severity Score
GG0130A1 | Self-Care (Adm Perf) - Eating
GG0130A3 | Self-Care (Dschg Perf) - Eating
GG0130B1 | Self-Care (Adm Perf) - Oral hygiene
GG0130B3 | Self-Care (Dschg Perf) - Oral hygiene
GG0130C1 | Self-Care (Adm Perf) - Toileting hygiene
GG0130C3 | Self-Care (Dschg Perf) - Toileting hygiene
GG0130E1 | Self-Care (Adm Perf) - Shower/bathe self
GG0130E3 | Self-Care (Dschg Perf) - Shower/bathe self
GG0130F1 | Self-Care (Adm Perf) - Upper Body Dressing
GG0130F3 | Self-Care (Dschg Perf) - Upper Body Dressing
GG0130G1 | Self-Care (Adm Perf) - Lower Body Dressing
GG0130G3 | Self-Care (Dschg Perf) - Lower Body Dressing
GG0130H1 | Self-Care (Adm Perf) - On/Off Footwear
GG0130H3 | Self-Care (Dschg Perf) - On/Off Footwear
GG0170A1 | Func Mobil (Adm Perf) - Roll left and right
GG0170A3 | Func Mobil (Dschg Perf) - Roll left and right
GG0170B1 | Func Mobil (Adm Perf) - Sit to lying
GG0170B3 | Func Mobil (Dschg Perf) - Sit to lying
GG0170C1 | Func Mobil (Adm Perf) - Lying to sit on side
GG0170C3 | Func Mobil (Dschg Perf) - Lying to sitting on side
GG0170D1 | Func Mobil (Adm Perf) - Sit to stand
GG0170D3 | Func Mobil (Dschg Perf) - Sit to stand
GG0170E1 | Func Mobil (Adm Perf) - Chair/bed-to-chair trans
GG0170E3 | Func Mobil (Dschg Perf) - Chair/bed-to-chair trans
GG0170F1 | Func Mobil (Adm Perf) - Toilet transfer
GG0170F3 | Func Mobil (Dschg Perf) - Toilet transfer
GG0170G1 | Func Mobil (Adm Perf) - Car Transfer
GG0170G3 | Func Mobil (Dschg Perf) - Car Transfer
GG0170I1 | Func Mobil (Adm Perf) - Walk 10 feet
GG0170I3 | Func Mobil (Dschg Perf) - Walk 10 feet
GG0170J1 | Func Mobil (Adm Perf) - 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
GG0170K3 | Func Mobil (Dschg Perf) - Walk 150 feet
GG0170L1 | Func Mobil (Adm Perf) - Walk 10 Ft Uneven Surf
GG0170L3 | Func Mobil (Dschg Perf) - Walk 10 Ft Uneven Surf
GG0170M1 | Func Mobil (Adm Perf) - 1 Step (Curb)
GG0170M3 | Func Mobil (Dschg Perf) - 1 Step (Curb)
GG0170N1 | Func Mobil (Adm Perf) - 4 Steps
GG0170N3 | Func Mobil (Dschg Perf) - 4 Steps
GG0170O1 | Func Mobil (Adm Perf) - 12 Steps
GG0170O3 | Func Mobil (Dschg Perf) - 12 Steps
GG0170P1 | Func Mobil (Adm Perf) - Picking Up Object
GG0170P3 | Func Mobil (Dschg Perf) - Picking Up Object
GG0170Q1 | Does patient use wheelchair and/or scooter (Adm)
GG0170Q3 | Does patient use wheelchair and/or scooter (Dschg)
GG0170R1 | Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns
GG0170R3 | Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns
GG0170RR1 | Indicate type of wheelchair or scooter (Adm)
GG0170RR3 | Indicate type of wheelchair or scooter (Dschg)
GG0170S1 | Func Mobil (Adm Perf) - Wheel 150 feet
GG0170S3 | Func Mobil (Dschg Perf) - Wheel 150 feet
GG0170SS1 | Indicate type of wheelchair or scooter (Adm)
GG0170SS3 | Indicate type of wheelchair or scooter (Dschg)
H0400 | Bowel Continence
I0900 | Diagnoses: Peripheral vascular disease (PVD)/PAD
I2900 | Diagnoses: Diabetes mellitus (DM)
J1900C | Num Falls Since Admission - Major injury
K0520A1 | Nutritional approach: Parenteral
K0520A4 | Nutritional approaches (7 days): Parenteral
K0520A5 | Nutritional approaches (discharge): Parenteral
K0520B1 | Nutritional approaches: Feeding tube
K0520B4 | Nutritional approaches (7 days): Feeding tube
K0520B5 | Nutritional approaches (discharge): Feeding Tube
K0520C1 | Nutritional approaches: Mechanically altered diet
K0520C4 | Nutritional approaches (7 days): mech altered diet
K0520C5 | Nutritional approaches (discharge): mech altered
K0520D1 | Nutritional approaches: Therapeutic diet
K0520D4 | Nutritional approaches (7 day): Therapeutic diet
K0520D5 | Nutritional approaches (discharge): Therapeutic
K0520Z1 | Nutritional approaches: None of the above
K0520Z4 | Nutritional approaches (7 days): None
K0520Z5 | Nutritional approaches (discharge): None
M0300B1_2 | Number of Stage 2 pressure ulcers: Discharge
M0300B2_2 | Nbr Disch Stg 2 PU were Adm Stg 2 PU
M0300C1_2 | Number of Stage 3 pressure ulcers: Discharge
M0300C2_2 | Nbr Disch Stg 3 PU were Adm Stg 3 PU
M0300D1_2 | Number of Stage 4 pressure ulcers: Discharge
M0300D2_2 | Nbr Disch Stg 4 PU were Adm Stg 4 PU
M0300E1_2 | Nbr Unstg non-remov drsg prss ulcers/injrs: Dschrg
M0300E2_2 | Nbr Unstg NRD Disch PU/Injrs present at Adm
M0300F1_2 | Nbr Unstg slough/eschar pressure ulcers: Dschrg
M0300F2_2 | Nbr Unstg S/E Disch PU were Adm Unstg S/E PU
M0300G1_2 | Nbr Unstg DTI pressure injrs: Dschrg
M0300G2_2 | Nbr Unstg DTI Disch PU/Injrs present at Adm
N0415A1_1 | High-Risk Drug (Is Taking): Antipsychotic
N0415A2_1 | High-Risk Drug (Indication) : Antipsychotic
N0415A1_2 | High-Risk Drug (Is Taking): Antipsychotic
N0415A2_2 | High-Risk Drug (Indication) : Antipsychotic
N0415E1_1 | High-Risk Drug (Is taking): Anticoagulant
N0415E2_1 | High-Risk Drug (Indication): Anticoagulant
N0415E1_2 | High-Risk Drug (Is taking): Anticoagulant
N0415E2_2 | High-Risk Drug (Indication): Anticoagulant
N0415F1_1 | High-Risk Drug (Is taking): Antibiotic
N0415F2_1 | High-Risk Drug (Indication): Antibiotic
N0415F1_2 | High-Risk Drug (Is taking): Antibiotic
N0415F2_2 | High-Risk Drug (Indication): Antibiotic
N0415H1_1 | High-Risk Drug (Is taking): Opioid
N0415H2_1 | High-Drug Risk (Indication): Opioid
N0415H1_2 | High-Risk Drug (Is taking): Opioid
N0415H2_2 | High-Drug Risk (Indication): Opioid
N0415I1_1 | High-Risk Drug (Is taking): Antiplatelet
N0415I2_1 | High-Risk Drug (Indication): Antiplatelet
N0415I1_2 | High-Risk Drug (Is taking): Antiplatelet
N0415I2_2 | High-Risk Drug (Indication): Antiplatelet
N0415J1_1 | High-Risk Drug (Is taking): Hypoglycemic
N0415J2_1 | High-Risk Drug (Indication): Hypoglycemic
N0415J1_2 | High-Risk Drug (Is taking): Hypoglycemic
N0415J2_2 | High-Risk Drug (Indication): Hypoglycemic
N0415Z1_1 | High-Risk Drug (Is taking): None of the above
N0415Z1_2 | 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: IV (Admission)
O0110A2c | Treatment: IV (Discharge)
O0110A3a | Treatment: Oral (Admission)
O0110A3c | Treatment: Oral (Discharge)
O0110A10a | Treatment: Other (Admission)
O0110A10c | Treatment: Other (Discharge)
O0110B1a | Treatment: Radiation (Admission)
O0110B1c | Treatment: Radiation (Discharge)
O0110C1a | Therapies: Oxygen Therapy (Admission)
O0110C1c | Therapies: Oxygen Therapy (Discharge)
O0110C2a | Therapies: Continuous (Admission)
O0110C2c | Therapies: Continuous (Discharge)
O0110C3a | Therapies: Intermittent (Admission)
O0110C3c | Therapies: Intermittent (Discharge)
O0110C4a | Therapies: High-concentration (Admission)
O0110C4c | Therapies: High-concentration (Discharge)
O0110D1a | Therapies: Suctioning (Admission)
O0110D1c | Therapies: Suctioning (Discharge)
O0110D2a | Therapies: Scheduled
O0110D2c | Therapies: Scheduled (Discharge)
O0110D3a | Therapies: As Needed (Admission)
O0110D3c | Therapies: As Needed (Discharge)
O0110E1a | Therapies: Tracheostomy Care (Admission)
O0110E1c | Therapies: Tracheostomy Care (Discharge)
O0110F1a | Therapies: Invasive Mechanical Ventilator (Admis)
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: Vasoactive medications (Admission)
O0110H2c | Other: Vasoactive medications (Discharge)
O0110H3a | Other: Antibiotics (Admission)
O0110H3c | Other: Antibiotics (Discharge)
O0110H4a | Other: Anticoagulation (Admission)
O0110H4c | Other: Anticoagulation (Discharge)
O0110H10a | Other: Other (Admission)
O0110H10c | Other: 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: Peripheral (Admission)
O0110O2c | Other: Peripheral (Discharge)
O0110O3a | Other: Midline (Admission)
O0110O3c | Other: Midline (Discharge)
O0110O4a | Other: Central (Admission)
O0110O4c | Other: Central (Discharge)
O0110Z1a | Other: None of the above (Admission)
O0110Z1c | Other: None of the above (Discharge)

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