IRF-PAI Item Summary

Item | XML Tag | Group | Type | Length | Fixed Start-End | Description
ASMT_SYS_CD | ASMT_SYS_CD | Control | Code | 10 | 1-10 | Assessment System Code

TRANS_TYPE_CD TRANS_TYPE_CD Control Code 1 11-11 Transaction Type Code
FAC_ID FAC_ID Control Text 10 12-21 Facility ID
STATE_CD STATE_CD Control Code 2 28-29 State Code
FAC_ADDR_1 FAC_ADDR_1 Control Text 30 30-59 Facility Address Line 1
FAC_ADDR_2 FAC_ADDR_2 Control Text 30 60-89 Facility Address Line 2
FAC_CITY FAC_CITY Control Text 20 90-109 Facility City
FAC_ZIP FAC_ZIP Control Text 5 110-114 Facility ZIP Code
FAC_CNTCT FAC_CNTCT Control Text 30 115-144 Facility Contact Person Name
FAC_PHONE FAC_PHONE Control Text 10 145-154 Facility Contact Person Phone
FAC_EXTEN FAC_EXTEN Control Text 5 155-159 Facility Contact Person Phone Extension
FAC_DOC_CD FAC_DOC_CD Control Text 8 160-167 Facility Document ID
ITM_SET_VRSN_CD ITM_SET_VRSN_CD Control Code 5 168-172 IRF-PAI item Set Version
SPEC_VRSN_CD SPEC_VRSN_CD Control Code 5 173-177 Specifications version code
SFTWR_VNDR_ID SFTWR_VNDR_ID Control Text 9 178-186 Software Vendor EIN
SFTWR_VNDR_NAME SFTWR_VNDR_NAME Control Text 30 187-216 Software Vendor Name
SFTWR_VNDR_EMAIL_ADR SFTWR_VNDR_EMAIL_ADR Control Text 50 217-266 Software Vendor Email Address
SFTWR_PROD_NAME SFTWR_PROD_NAME Control Text 50 267-316 Software Product Name
SFTWR_PROD_VRSN_CD SFTWR_PROD_VRSN_CD Control Text 20 317-336 Software Product Version Code
CORRECTION_NUM CORRECTION_NUM Control Number 2 337-338 Correction Number
SBMTD_CMG_TXT SBMTD_CMG_TXT Control Text 10 2139-2148 Submitted CMG Code
SBMTD_CMG_VRSN_TXT SBMTD_CMG_VRSN_TXT Control Text 10 2159-2168 Submitted CMG Version Code
CONTROL_FILLER CNTRL_FLR Control Text 200 339-538 Control items filler
1A R1A Asmt Text 50 539-588 Facility Name
1B R1B Asmt Text 12 589-600 CMS Certification Number (CCN)
2 R2 Asmt Text 12 601-612 Patient Medicare Number
3 R3 Asmt Text 14 613-626 Patient Medicaid Number
4 R4 Asmt Text 12 627-638 Patient First Name
5A R5A Asmt Text 18 639-656 Patient Last Name
6 R6 Asmt Date 8 657-664 Birth Date
7 R7 Asmt Text 9 665-673 Social Security Number (SSN)
8 R8 Asmt Code 1 674-674 Gender
Filler - 9A R9A Filler Checklist 1 675-675 Filler for deleted item
Filler - 9B R9B Filler Checklist 1 676-676 Filler for deleted item
Filler - 9C R9C Filler Checklist 1 677-677 Filler for deleted item
Filler - 9D R9D Filler Checklist 1 678-678 Filler for deleted item
Filler - 9E R9E Filler Checklist 1 679-679 Filler for deleted item
Filler - 9F R9F Filler Checklist 1 680-680 Filler for deleted item
10 R10 Asmt Code 2 681-682 Marital Status
11 R11 Asmt Text 5 683-687 ZIP Code of Patient"s Pre-hospital Residence
12 R12 Asmt Date 8 688-695 Admission Date
13 R13 Asmt Date 8 696-703 Assessment Reference Date
14 R14 Asmt Code 2 704-705 Admission Class
15A R15A Asmt Code 2 1128-1129 Admit From
16A R16A Asmt Code 2 1130-1131 Pre-hospital Living Setting
17 R17 Asmt Code 2 710-711 Pre-Hospital Living With
20A R20A Asmt Code 2 716-717 Primary Payment Source
20B R20B Asmt Code 2 718-719 Secondary Payment Source
21A R21A Asmt Code 9 720-728 Impairment Group: Admission
21D R21D Asmt Code 9 729-737 Impairment Group: Discharge
22A R22A Asmt ICD 8 1426-1433 Etiologic Diagnosis Code A (ICD Code)
22B R22B Asmt ICD 8 1313-1320 Etiologic Diagnosis Code B (ICD Code)
22C R22C Asmt ICD 8 1321-1328 Etiologic Diagnosis Code C (ICD Code)
23 R23 Asmt Date 8 746-753 Date of Onset of Impairment
24A R24A Asmt ICD 8 754-761 Comorbid Condition 1 (ICD Code)
24B R24B Asmt ICD 8 762-769 Comorbid Condition 2 (ICD Code)
24C R24C Asmt ICD 8 770-777 Comorbid Condition 3 (ICD Code)
24D R24D Asmt ICD 8 778-785 Comorbid Condition 4 (ICD Code)
24E R24E Asmt ICD 8 786-793 Comorbid Condition 5 (ICD Code)
24F R24F Asmt ICD 8 794-801 Comorbid Condition 6 (ICD Code)
24G R24G Asmt ICD 8 802-809 Comorbid Condition 7 (ICD Code)
24H R24H Asmt ICD 8 810-817 Comorbid Condition 8 (ICD Code)
24I R24I Asmt ICD 8 818-825 Comorbid Condition 9 (ICD Code)
24J R24J Asmt ICD 8 826-833 Comorbid Condition 10 (ICD Code)
24K R24K Asmt ICD 8 1132-1139 Comorbid Condition 11 (ICD Code)
24L R24L Asmt ICD 8 1140-1147 Comorbid Condition 12 (ICD Code)
24M R24M Asmt ICD 8 1148-1155 Comorbid Condition 13 (ICD Code)
24N R24N Asmt ICD 8 1156-1163 Comorbid Condition 14 (ICD Code)
24O R24O Asmt ICD 8 1164-1171 Comorbid Condition 15 (ICD Code)
24P R24P Asmt ICD 8 1172-1179 Comorbid Condition 16 (ICD Code)
24Q R24Q Asmt ICD 8 1180-1187 Comorbid Condition 17 (ICD Code)
24R R24R Asmt ICD 8 1188-1195 Comorbid Condition 18 (ICD Code)
24S R24S Asmt ICD 8 1196-1203 Comorbid Condition 19 (ICD Code)
24T R24T Asmt ICD 8 1204-1211 Comorbid Condition 20 (ICD Code)
24U R24U Asmt ICD 8 1212-1219 Comorbid Condition 21 (ICD Code)
24V R24V Asmt ICD 8 1220-1227 Comorbid Condition 22 (ICD Code)
24W R24W Asmt ICD 8 1228-1235 Comorbid Condition 23 (ICD Code)
24X R24X Asmt ICD 8 1236-1243 Comorbid Condition 24 (ICD Code)
24Y R24Y Asmt ICD 8 1244-1251 Comorbid Condition 25 (ICD Code)
24A1 R24A1 Asmt Code 1 1329-1329 Arthritis Conditions Recorded
25A R25A Asmt Number 2 1252-1253 Height
26A R26A Asmt Number 3 1254-1256 Weight
40 R40 Asmt Date 8 996-1003 Discharge Date
41 R41 Asmt Code 1 1004-1004 Patient Discharged Against Medical Advice
42 R42 Asmt Code 1 1005-1005 Program Interruption(s) Indicator
43A R43A Asmt Date 8 1006-1013 1st Interruption Date
43B R43B Asmt Date 8 1014-1021 1st Return Date
43C R43C Asmt Date 8 1022-1029 2nd Interruption Date
43D R43D Asmt Date 8 1030-1037 2nd Return Date
43E R43E Asmt Date 8 1038-1045 3rd Interruption Date
43F R43F Asmt Date 8 1046-1053 3rd Return Date
44C R44C Asmt Code 1 1257-1257 Patient Discharged Alive
44D R44D Asmt Code 2 1259-1260 Discharge to Living Setting
45 R45 Asmt Code 2 1057-1058 Discharge to Living With
46 R46 Asmt ICD 8 1059-1066 Diagnosis for Interruption or Death (ICD Code)
47A R47A Asmt ICD 8 1067-1074 Complication during rehab stay 1 (ICD Code)
47B R47B Asmt ICD 8 1075-1082 Complication during rehab stay 2 (ICD Code)
47C R47C Asmt ICD 8 1083-1090 Complication during rehab stay 3 (ICD Code)
47D R47D Asmt ICD 8 1091-1098 Complication during rehab stay 4 (ICD Code)
47E R47E Asmt ICD 8 1099-1106 Complication during rehab stay 5 (ICD Code)
47F R47F Asmt ICD 8 1107-1114 Complication during rehab stay 6 (ICD Code)
O0401AA O0401AA Asmt Number 4 1330-1333 Physical Therapy - Individual Minutes Week 1
O0401AB O0401AB Asmt Number 4 1334-1337 Physical Therapy - Concurrent Minutes Week 1
O0401AC O0401AC Asmt Number 4 1338-1341 Physical Therapy - Group Minutes Week 1
O0401AD O0401AD Asmt Number 4 1342-1345 Physical Therapy - Co-treatment Minutes Week 1
O0401BA O0401BA Asmt Number 4 1346-1349 Occupational Therapy - Individual Minutes Week 1
O0401BB O0401BB Asmt Number 4 1350-1353 Occupational Therapy - Concurrent Minutes Week 1
O0401BC O0401BC Asmt Number 4 1354-1357 Occupational Therapy - Group Minutes Week 1
O0401BD O0401BD Asmt Number 4 1358-1361 Occupational Therapy - Co-treatment Minutes Week 1
O0401CA O0401CA Asmt Number 4 1362-1365 SLP Therapy - Individual Minutes Week 1
O0401CB O0401CB Asmt Number 4 1366-1369 SLP Therapy - Concurrent Minutes Week 1
O0401CC O0401CC Asmt Number 4 1370-1373 SLP Therapy - Group Minutes Week 1
O0401CD O0401CD Asmt Number 4 1374-1377 SLP Therapy - Co-treatment Minutes Week 1
O0402AA O0402AA Asmt Number 4 1378-1381 Physical Therapy - Individual Minutes Week 2
O0402AB O0402AB Asmt Number 4 1382-1385 Physical Therapy - Concurrent Minutes Week 2
O0402AC O0402AC Asmt Number 4 1386-1389 Physical Therapy - Group Minutes Week 2
O0402AD O0402AD Asmt Number 4 1390-1393 Physical Therapy - Co-treatment Minutes Week 2
O0402BA O0402BA Asmt Number 4 1394-1397 Occupational Therapy - Individual Minutes Week 2
O0402BB O0402BB Asmt Number 4 1398-1401 Occupational Therapy - Concurrent Minutes Week 2
O0402BC O0402BC Asmt Number 4 1402-1405 Occupational Therapy - Group Minutes Week 2
O0402BD O0402BD Asmt Number 4 1406-1409 Occupational Therapy - Co-treatment Minutes Week 2
O0402CA O0402CA Asmt Number 4 1410-1413 SLP Therapy - Individual Minutes Week 2
O0402CB O0402CB Asmt Number 4 1414-1417 SLP Therapy - Concurrent Minutes Week 2
O0402CC O0402CC Asmt Number 4 1418-1421 SLP Therapy - Group Minutes Week 2
O0402CD O0402CD Asmt Number 4 1422-1425 SLP Therapy - Co-treatment Minutes Week 2
A1005A A1005A Asmt Checklist 1 1648-1648 Ethnicity: No, not Hispanic, Latino/a or Spanish
A1005B A1005B Asmt Checklist 1 1649-1649 Ethnicity: Yes, Mexican, Mexican American, Chicano
A1005C A1005C Asmt Checklist 1 1650-1650 Ethincity: Yes, Puerto Rican.
A1005D A1005D Asmt Checklist 1 1651-1651 Ethnicity: Yes, Cuban
A1005E A1005E Asmt Checklist 1 1652-1652 Ethnicity: Yes,another Hispanic, Latino or Spanish
A1005X A1005X Asmt Checklist 1 1653-1653 Ethnicity: Patient unable to respond
A1010A A1010A Asmt Checklist 1 1654-1654 Race: White
A1010B A1010B Asmt Checklist 1 1655-1655 Race: Black or African American
A1010C A1010C Asmt Checklist 1 1656-1656 Race: American Indian or Alaska Native
A1010D A1010D Asmt Checklist 1 1657-1657 Race: Asian Indian
A1010E A1010E Asmt Checklist 1 1658-1658 Race: Chinese
A1010F A1010F Asmt Checklist 1 1659-1659 Race: Filipino
A1010G A1010G Asmt Checklist 1 1660-1660 Race: Japanese
A1010H A1010H Asmt Checklist 1 1661-1661 Race: Korean
A1010I A1010I Asmt Checklist 1 1662-1662 Race: Vietnamese
A1010J A1010J Asmt Checklist 1 1663-1663 Race: Other Asian
A1010K A1010K Asmt Checklist 1 1664-1664 Race: Native Hawaiian
A1010L A1010L Asmt Checklist 1 1665-1665 Race: Guamanian or Chamorro
A1010M A1010M Asmt Checklist 1 1666-1666 Race: Samoan
A1010N A1010N Asmt Checklist 1 1667-1667 Race: Other Pacific Islander
A1010X A1010X Asmt Checklist 1 1668-1668 Race: Patient unable to respond
A1110A A1110A Asmt Text 15 1669-1683 Preferred language
A1110B A1110B Asmt Code 1 1684-1684 Does the patient need or want an interpreter
A1250A_1 A1250A_1 Asmt Checklist 1 1685-1685 Yes, it has kept me from medical appointments
A1250A_2 A1250A_2 Asmt Checklist 1 1686-1686 Yes, it has kept me from medical appointments
A1250B_1 A1250B_1 Asmt Checklist 1 1687-1687 Yes, it has kept me from non-medical appointments
A1250B_2 A1250B_2 Asmt Checklist 1 1688-1688 Yes, it has kept me from non-medical appointments
A1250C_1 A1250C_1 Asmt Checklist 1 1689-1689 No
A1250C_2 A1250C_2 Asmt Checklist 1 1690-1690 No
A1250X_1 A1250X_1 Asmt Checklist 1 1691-1691 Patient unable to respond
A1250X_2 A1250X_2 Asmt Checklist 1 1692-1692 Patient unable to respond
A2121 A2121 Asmt Code 1 1693-1693 Provision of Current Reconciled Medication List
A2122A A2122A Asmt Checklist 1 1694-1694 Electronic Health Record
A2122B A2122B Asmt Checklist 1 1695-1695 Health Information Exchange Organization
A2122C A2122C Asmt Checklist 1 1696-1696 Verbal
A2122D A2122D Asmt Checklist 1 1697-1697 Paper-based
A2122E A2122E Asmt Checklist 1 1698-1698 Other Methods
A2123 A2123 Asmt Code 1 1699-1699 Provision of Current Reconciled Medication List
A2124A A2124A Asmt Checklist 1 1700-1700 Electronic Health Record
A2124B A2124B Asmt Checklist 1 1701-1701 Health Information Exchange Organization
A2124C A2124C Asmt Checklist 1 1702-1702 Verbal
A2124D A2124D Asmt Checklist 1 1703-1703 Paper-based
A2124E A2124E Asmt Checklist 1 1704-1704 Other Methods
B0200 B0200 Asmt Code 1 1705-1705 Hearing
B1000 B1000 Asmt Code 1 1706-1706 Vision
B1300_1 B1300_1 Asmt Code 1 1707-1707 Health Literacy
B1300_2 B1300_2 Asmt Code 1 1708-1708 Health Literacy
BB0700 BB0700 Asmt Code 1 1434-1434 Expression of Ideas and Wants (3-day asmt period)
BB0800 BB0800 Asmt Code 1 1435-1435 Undrstnd Vrbl/Non-Vrbl Content (3-day asmt period)
C0100 C0100_1 Asmt Code 1 1436-1436 Brief Interview - Mental Status (BIMS)
C0100_2 C0100_2 Asmt Code 1 1437-1437 Brief Interview - Mental Status (BIMS)
C0200 C0200_1 Asmt Code 1 1438-1438 BIMS - Repetition of Three Words
C0200_2 C0200_2 Asmt Code 1 1439-1439 BIMS - Repetition of Three Words
C0300A C0300A_1 Asmt Code 1 1440-1440 BIMS - Temporal Orientation - Year
C0300A_2 C0300A_2 Asmt Code 1 1441-1441 BIMS - Temporal Orientation - Year
C0300B C0300B_1 Asmt Code 1 1442-1442 BIMS - Temporal Orientation - Month
C0300B_2 C0300B_2 Asmt Code 1 1443-1443 BIMS - Temporal Orientation - Month
C0300C C0300C_1 Asmt Code 1 1444-1444 BIMS - Temporal Orientation - Day
C0300C_2 C0300C_2 Asmt Code 1 1445-1445 BIMS - Temporal Orientation - Day
C0400A C0400A_1 Asmt Code 1 1446-1446 BIMS - Recalls Sock
C0400A_2 C0400A_2 Asmt Code 1 1447-1447 BIMS - Recalls Sock
C0400B C0400B_1 Asmt Code 1 1448-1448 BIMS - Recalls Blue
C0400B_2 C0400B_2 Asmt Code 1 1449-1449 BIMS - Recalls Blue
C0400C C0400C_1 Asmt Code 1 1450-1450 BIMS - Recalls Bed
C0400C_2 C0400C_2 Asmt Code 1 1451-1451 BIMS - Recalls Bed
C0500 C0500_1 Asmt Number 2 1452-1453 BIMS - Summary Score
C0500_2 C0500_2 Asmt Number 2 1454-1455 BIMS - Summary Score
C0600 C0600 Asmt Code 1 1456-1456 Conduct Staff Assessment - Mental Status
C0900A C0900A Asmt Checklist 1 1457-1457 Memory/Recall - Current Season (3-day Asmt Prd)
C0900B C0900B Asmt Checklist 1 1458-1458 Memory/Recall - Loc Of Own Room (3-day Asmt Prd)
C0900C C0900C Asmt Checklist 1 1459-1459 Memory/Recall - Staff Names/Faces (3-day Asmt Prd)
C0900E C0900E Asmt Checklist 1 1460-1460 Memory/Recall - In Hospital Unit (3-day Asmt Prd)
C0900Z C0900Z Asmt Checklist 1 1461-1461 Memory/Recall - None Of The Above (3-day Asmt Prd)
C1310A_1 C1310A_1 Asmt Code 1 1709-1709 Acute Onset Mental Status Change
C1310A_2 C1310A_2 Asmt Code 1 1710-1710 Acute Onset Mental Status Change
C1310B_1 C1310B_1 Asmt Code 1 1711-1711 Inattention
C1310B_2 C1310B_2 Asmt Code 1 1712-1712 Inattention
C1310C_1 C1310C_1 Asmt Code 1 1713-1713 Disorganized thinking
C1310C_2 C1310C_2 Asmt Code 1 1714-1714 Disorganized thinking
C1310D_1 C1310D_1 Asmt Code 1 1715-1715 Altered level of consciousness
C1310D_2 C1310D_2 Asmt Code 1 1716-1716 Altered level of consciousness
D0150A1_1 D0150A1_1 Asmt Code 1 1717-1717 Little interest or pleasure in doing things: Presc
D0150A2_1 D0150A2_1 Asmt Code 1 1718-1718 Little interest or pleasure in doing things: Freq
D0150A1_2 D0150A1_2 Asmt Code 1 1719-1719 Little interest or pleasure in doing things: Presc
D0150A2_2 D0150A2_2 Asmt Code 1 1720-1720 Little interest or pleasure in doing things: Freq
D0150B1_1 D0150B1_1 Asmt Code 1 1721-1721 Feeling down, depressed, or hopeless: Presc
D0150B2_1 D0150B2_1 Asmt Code 1 1722-1722 Feeling down, depressed, or hopeless: Freq
D0150B1_2 D0150B1_2 Asmt Code 1 1723-1723 Feeling down, depressed, or hopeless: Presc
D0150B2_2 D0150B2_2 Asmt Code 1 1724-1724 Feeling down, depressed, or hopeless: Freq
D0150C1_1 D0150C1_1 Asmt Code 1 1725-1725 Trouble falling or staying asleep: Presc
D0150C2_1 D0150C2_1 Asmt Code 1 1726-1726 Trouble falling or staying asleep: Freq
D0150C1_2 D0150C1_2 Asmt Code 1 1727-1727 Trouble falling or staying asleep: Presc
D0150C2_2 D0150C2_2 Asmt Code 1 1728-1728 Trouble falling or staying asleep: Freq
D0150D1_1 D0150D1_1 Asmt Code 1 1729-1729 Feeling tired or having little energy: Presc
D0150D2_1 D0150D2_1 Asmt Code 1 1730-1730 Feeling tired or having little energy: Freq
D0150D1_2 D0150D1_2 Asmt Code 1 1731-1731 Feeling tired or having little energy: Presc
D0150D2_2 D0150D2_2 Asmt Code 1 1732-1732 Feeling tired or having little energy: Freq
D0150E1_1 D0150E1_1 Asmt Code 1 1733-1733 Poor appetite or overeating: Presc
D0150E2_1 D0150E2_1 Asmt Code 1 1734-1734 Poor appetite or overeating: Freq
D0150E1_2 D0150E1_2 Asmt Code 1 1735-1735 Poor appetite or overeating: Presc
D0150E2_2 D0150E2_2 Asmt Code 1 1736-1736 Poor appetite or overeating: Freq
D0150F1_1 D0150F1_1 Asmt Code 1 1737-1737 Feeling bad about yourself: Presc
D0150F2_1 D0150F2_1 Asmt Code 1 1738-1738 Feeling bad about yourself: Freq
D0150F1_2 D0150F1_2 Asmt Code 1 1739-1739 Feeling bad about yourself: Presc
D0150F2_2 D0150F2_2 Asmt Code 1 1740-1740 Feeling bad about yourself: Freq
D0150G1_1 D0150G1_1 Asmt Code 1 1741-1741 Trouble concentrating on things: Presc
D0150G2_1 D0150G2_1 Asmt Code 1 1742-1742 Trouble concentrating on things: Freq
D0150G1_2 D0150G1_2 Asmt Code 1 1743-1743 Trouble concentrating on things: Presc
D0150G2_2 D0150G2_2 Asmt Code 1 1744-1744 Trouble concentrating on things: Freq
D0150H1_1 D0150H1_1 Asmt Code 1 1745-1745 Moving or speaking so slowly: Presc
D0150H2_1 D0150H2_1 Asmt Code 1 1746-1746 Moving or speaking so slowly: Freq
D0150H1_2 D0150H1_2 Asmt Code 1 1747-1747 Moving or speaking so slowly: Presc
D0150H2_2 D0150H2_2 Asmt Code 1 1748-1748 Moving or speaking so slowly: Freq
D0150I1_1 D0150I1_1 Asmt Code 1 1749-1749 Thoughts that you would be better off dead: Presc
D0150I2_1 D0150I2_1 Asmt Code 1 1750-1750 Thoughts that you would be better off dead: Freq
D0150I1_2 D0150I1_2 Asmt Code 1 1751-1751 Thoughts that you would be better off dead: Presc
D0150I2_2 D0150I2_2 Asmt Code 1 1752-1752 Thoughts that you would be better off dead: Freq
D0160_1 D0160_1 Asmt Number 2 1753-1754 Total Severity Score
D0160_2 D0160_2 Asmt Number 2 1755-1756 Total Severity Score
D0700_1 D0700_1 Asmt Code 1 1757-1757 Social Isolation
D0700_2 D0700_2 Asmt Code 1 1758-1758 Social Isolation
GG0100A GG0100A Asmt Code 1 1462-1462 Prior Function - Self Care
GG0100B GG0100B Asmt Code 1 1463-1463 Prior Function - Indoor Mobility (Ambulation)
GG0100C GG0100C Asmt Code 1 1464-1464 Prior Function - Stairs
GG0100D GG0100D Asmt Code 1 1465-1465 Prior Function - Functional Cognition
GG0110A GG0110A Asmt Checklist 1 1466-1466 Prior Device - Manual wheelchair
GG0110B GG0110B Asmt Checklist 1 1467-1467 Prior Device - Motorized wheelchair and/or scooter
GG0110C GG0110C Asmt Checklist 1 1468-1468 Prior Device - Mechanical lift
GG0110D GG0110D Asmt Checklist 1 1469-1469 Prior Device - Walker
GG0110E GG0110E Asmt Checklist 1 1470-1470 Prior Device - Orthotics/Prosthetics
GG0110Z GG0110Z Asmt Checklist 1 1471-1471 Prior Device - None of the above
GG0130A1 GG0130A1 Asmt Code 2 1472-1473 Self-Care (Adm Perf) - Eating
GG0130A2 GG0130A2 Asmt Code 2 1474-1475 Self-Care (Dschg Goal) - Eating
GG0130A3 GG0130A3 Asmt Code 2 1476-1477 Self-Care (Dschg Perf) - Eating
GG0130B1 GG0130B1 Asmt Code 2 1478-1479 Self-Care (Adm Perf) - Oral hygiene
GG0130B2 GG0130B2 Asmt Code 2 1480-1481 Self-Care (Dschg Goal) - Oral hygiene
GG0130B3 GG0130B3 Asmt Code 2 1482-1483 Self-Care (Dschg Perf) - Oral hygiene
GG0130C1 GG0130C1 Asmt Code 2 1484-1485 Self-Care (Adm Perf) - Toileting hygiene
GG0130C2 GG0130C2 Asmt Code 2 1486-1487 Self-Care (Dschg Goal) - Toileting hygiene
GG0130C3 GG0130C3 Asmt Code 2 1488-1489 Self-Care (Dschg Perf) - Toileting hygiene
GG0130E1 GG0130E1 Asmt Code 2 1490-1491 Self-Care (Adm Perf) - Shower/bathe self
GG0130E2 GG0130E2 Asmt Code 2 1492-1493 Self-Care (Dschg Goal) - Shower/bathe self
GG0130E3 GG0130E3 Asmt Code 2 1494-1495 Self-Care (Dschg Perf) - Shower/bathe self
GG0130F1 GG0130F1 Asmt Code 2 1496-1497 Self-Care (Adm Perf) - Upper Body Dressing
GG0130F2 GG0130F2 Asmt Code 2 1498-1499 Self-Care (Dschg Goal) - Upper Body Dressing
GG0130F3 GG0130F3 Asmt Code 2 1500-1501 Self-Care (Dschg Perf) - Upper Body Dressing
GG0130G1 GG0130G1 Asmt Code 2 1502-1503 Self-Care (Adm Perf) - Lower Body Dressing
GG0130G2 GG0130G2 Asmt Code 2 1504-1505 Self-Care (Dschg Goal) - Lower Body Dressing
GG0130G3 GG0130G3 Asmt Code 2 1506-1507 Self-Care (Dschg Perf) - Lower Body Dressing
GG0130H1 GG0130H1 Asmt Code 2 1508-1509 Self-Care (Adm Perf) - On/Off Footwear
GG0130H2 GG0130H2 Asmt Code 2 1510-1511 Self-Care (Dschg Goal) - On/Off Footwear
GG0130H3 GG0130H3 Asmt Code 2 1512-1513 Self-Care (Dschg Perf) - On/Off Footwear
GG0170A1 GG0170A1 Asmt Code 2 1514-1515 Func Mobil (Adm Perf) - Roll left and right
GG0170A2 GG0170A2 Asmt Code 2 1516-1517 Func Mobil (Dschg Goal) - Roll left and right
GG0170A3 GG0170A3 Asmt Code 2 1518-1519 Func Mobil (Dschg Perf) - Roll left and right
GG0170B1 GG0170B1 Asmt Code 2 1520-1521 Func Mobil (Adm Perf) - Sit to lying
GG0170B2 GG0170B2 Asmt Code 2 1522-1523 Func Mobil (Dschg Goal) - Sit to lying
GG0170B3 GG0170B3 Asmt Code 2 1524-1525 Func Mobil (Dschg Perf) - Sit to lying
GG0170C1 GG0170C1 Asmt Code 2 1526-1527 Func Mobil (Adm Perf) - Lying to sit on side
GG0170C2 GG0170C2 Asmt Code 2 1528-1529 Func Mobil (Dschg Goal) - Lying to sitting on side
GG0170C3 GG0170C3 Asmt Code 2 1530-1531 Func Mobil (Dschg Perf) - Lying to sitting on side
GG0170D1 GG0170D1 Asmt Code 2 1532-1533 Func Mobil (Adm Perf) - Sit to stand
GG0170D2 GG0170D2 Asmt Code 2 1534-1535 Func Mobil (Dschg Goal) - Sit to stand
GG0170D3 GG0170D3 Asmt Code 2 1536-1537 Func Mobil (Dschg Perf) - Sit to stand
GG0170E1 GG0170E1 Asmt Code 2 1538-1539 Func Mobil (Adm Perf) - Chair/bed-to-chair trans
GG0170E2 GG0170E2 Asmt Code 2 1540-1541 Func Mobil (Dschg Goal) - Chair/bed-to-chair trans
GG0170E3 GG0170E3 Asmt Code 2 1542-1543 Func Mobil (Dschg Perf) - Chair/bed-to-chair trans
GG0170F1 GG0170F1 Asmt Code 2 1544-1545 Func Mobil (Adm Perf) - Toilet transfer
GG0170F2 GG0170F2 Asmt Code 2 1546-1547 Func Mobil (Dschg Goal) - Toilet transfer
GG0170F3 GG0170F3 Asmt Code 2 1548-1549 Func Mobil (Dschg Perf) - Toilet transfer
GG0170G1 GG0170G1 Asmt Code 2 1550-1551 Func Mobil (Adm Perf) - Car Transfer
GG0170G2 GG0170G2 Asmt Code 2 1552-1553 Func Mobil (Dschg Goal) - Car Transfer
GG0170G3 GG0170G3 Asmt Code 2 1554-1555 Func Mobil (Dschg Perf) - Car Transfer
GG0170I1 GG0170I1 Asmt Code 2 1558-1559 Func Mobil (Adm Perf) - Walk 10 feet
GG0170I2 GG0170I2 Asmt Code 2 1560-1561 Func Mobil (Dschg Goal) - Walk 10 feet
GG0170I3 GG0170I3 Asmt Code 2 1562-1563 Func Mobil (Dschg Perf) - Walk 10 feet
GG0170J1 GG0170J1 Asmt Code 2 1564-1565 Func Mobil (Adm Perf) - Walk 50 feet w/2 turns
GG0170J2 GG0170J2 Asmt Code 2 1566-1567 Func Mobil (Dschg Goal) - Walk 50 feet w/2 turns
GG0170J3 GG0170J3 Asmt Code 2 1568-1569 Func Mobil (Dschg Perf) - Walk 50 feet w/2 turns
GG0170K1 GG0170K1 Asmt Code 2 1570-1571 Func Mobil (Adm Perf) - Walk 150 feet
GG0170K2 GG0170K2 Asmt Code 2 1572-1573 Func Mobil (Dschg Goal) - Walk 150 feet
GG0170K3 GG0170K3 Asmt Code 2 1574-1575 Func Mobil (Dschg Perf) - Walk 150 feet
GG0170L1 GG0170L1 Asmt Code 2 1576-1577 Func Mobil (Adm Perf) - Walk 10 Ft Uneven Surf
GG0170L2 GG0170L2 Asmt Code 2 1578-1579 Func Mobil (Dschg Goal) - Walk 10 Ft Uneven Surf
GG0170L3 GG0170L3 Asmt Code 2 1580-1581 Func Mobil (Dschg Perf) - Walk 10 Ft Uneven Surf
GG0170M1 GG0170M1 Asmt Code 2 1582-1583 Func Mobil (Adm Perf) - 1 Step (Curb)
GG0170M2 GG0170M2 Asmt Code 2 1584-1585 Func Mobil (Dschg Goal) - 1 Step (Curb)
GG0170M3 GG0170M3 Asmt Code 2 1586-1587 Func Mobil (Dschg Perf) - 1 Step (Curb)
GG0170N1 GG0170N1 Asmt Code 2 1588-1589 Func Mobil (Adm Perf) - 4 Steps
GG0170N2 GG0170N2 Asmt Code 2 1590-1591 Func Mobil (Dschg Goal) - 4 Steps
GG0170N3 GG0170N3 Asmt Code 2 1592-1593 Func Mobil (Dschg Perf) - 4 Steps
GG0170O1 GG0170O1 Asmt Code 2 1594-1595 Func Mobil (Adm Perf) - 12 Steps
GG0170O2 GG0170O2 Asmt Code 2 1596-1597 Func Mobil (Dschg Goal) - 12 Steps
GG0170O3 GG0170O3 Asmt Code 2 1598-1599 Func Mobil (Dschg Perf) - 12 Steps
GG0170P1 GG0170P1 Asmt Code 2 1600-1601 Func Mobil (Adm Perf) - Picking Up Object
GG0170P2 GG0170P2 Asmt Code 2 1602-1603 Func Mobil (Dschg Goal) - Picking Up Object
GG0170P3 GG0170P3 Asmt Code 2 1604-1605 Func Mobil (Dschg Perf) - Picking Up Object
GG0170Q1 GG0170Q1 Asmt Code 1 1606-1606 Does patient use wheelchair and/or scooter (Adm)
GG0170Q3 GG0170Q3 Asmt Code 1 1607-1607 Does patient use wheelchair and/or scooter (Dschg)
GG0170R1 GG0170R1 Asmt Code 2 1608-1609 Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns
GG0170R2 GG0170R2 Asmt Code 2 1610-1611 Func Mobil (Dschg Goal) - Wheel 50 feet w/2 turns
GG0170R3 GG0170R3 Asmt Code 2 1612-1613 Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns
GG0170RR1 GG0170RR1 Asmt Code 1 1614-1614 Indicate type of wheelchair or scooter (Adm)
GG0170RR3 GG0170RR3 Asmt Code 1 1615-1615 Indicate type of wheelchair or scooter (Dschg)
GG0170S1 GG0170S1 Asmt Code 2 1616-1617 Func Mobil (Adm Perf) - Wheel 150 feet
GG0170S2 GG0170S2 Asmt Code 2 1618-1619 Func Mobil (Dschg Goal) - Wheel 150 feet
GG0170S3 GG0170S3 Asmt Code 2 1620-1621 Func Mobil (Dschg Perf) - Wheel 150 feet
GG0170SS1 GG0170SS1 Asmt Code 1 1622-1622 Indicate type of wheelchair or scooter (Adm)
GG0170SS3 GG0170SS3 Asmt Code 1 1623-1623 Indicate type of wheelchair or scooter (Dschg)
H0350 H0350 Asmt Code 1 1624-1624 Bladder Continence
H0400 H0400 Asmt Code 1 1625-1625 Bowel Continence
I0900 I0900 Asmt Checklist 1 1626-1626 Diagnoses: Peripheral vascular disease (PVD)/PAD
I2900 I2900 Asmt Checklist 1 1627-1627 Diagnoses: Diabetes mellitus (DM)
I7900 I7900 Asmt Checklist 1 1628-1628 Diagnoses: None of the Above
J0510_1 J0510_1 Asmt Code 1 1759-1759 Pain effect on sleep
J0510_2 J0510_2 Asmt Code 1 1760-1760 Pain effect on sleep
J0520_1 J0520_1 Asmt Code 1 1761-1761 Pain interference with therapy activities
J0520_2 J0520_2 Asmt Code 1 1762-1762 Pain interference with therapy activities
J0530_1 J0530_1 Asmt Code 1 1763-1763 Pain interference with day-to-day activities
J0530_2 J0530_2 Asmt Code 1 1764-1764 Pain interference with day-to-day activities
J1750 J1750 Asmt Code 1 1629-1629 History of Falls
J1800 J1800 Asmt Code 1 1630-1630 Any Falls Since Admission
J1900A J1900A Asmt Code 1 1631-1631 Num Falls Since Admission - No injury
J1900B J1900B Asmt Code 1 1632-1632 Num Falls Since Admission - Injury (except major)
J1900C J1900C Asmt Code 1 1633-1633 Num Falls Since Admission - Major injury
J2000 J2000 Asmt Code 1 1634-1634 Prior Surgery
K0520A1 K0520A1 Asmt Checklist 1 1765-1765 Nutritional approach: Parenteral
K0520A4 K0520A4 Asmt Checklist 1 1766-1766 Nutritional approaches (7 days): Parenteral
K0520A5 K0250A5 Asmt Checklist 1 1767-1767 Nutritional approaches (discharge): Parenteral
K0520B1 K0520B1 Asmt Checklist 1 1768-1768 Nutritional approaches: Feeding tube
K0520B4 K0520B4 Asmt Checklist 1 1769-1769 Nutritional approaches (7 days): Feeding tube
K0520B5 K0520B5 Asmt Checklist 1 1770-1770 Nutritional approaches (discharge): Feeding Tube
K0520C1 K0520C1 Asmt Checklist 1 1771-1771 Nutritional approaches: Mechanically altered diet
K0520C4 K0520C4 Asmt Checklist 1 1772-1772 Nutritional approaches (7 days): mech altered diet
K0520C5 K0520C5 Asmt Checklist 1 1773-1773 Nutritional approaches (discharge): mech altered
K0520D1 K0520D1 Asmt Checklist 1 1774-1774 Nutritional approaches: Therapeutic diet
K0520D4 K0520D4 Asmt Checklist 1 1775-1775 Nutritional approaches (7 day): Therapeutic diet
K0520D5 K0520D5 Asmt Checklist 1 1776-1776 Nutritional approaches (discharge): Therapeutic
K0520Z1 K0520Z1 Asmt Checklist 1 1777-1777 Nutritional approaches: None of the above
K0520Z4 K0520Z4 Asmt Checklist 1 1778-1778 Nutritional approaches (7 days): None
K0520Z5 K0520Z5 Asmt Checklist 1 1779-1779 Nutritional approaches (discharge): None
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Filler - K0110C K0110C Filler Checklist 1 1637-1637 Filler for deleted item
M0210_1 M0210_1 Asmt Code 1 1261-1261 Pressure Ulcers/Injuries Present on Admission
M0210_2 M0210_2 Asmt Code 1 1262-1262 Pressure Ulcers/Injuries Present on Discharge
M0300A1_1 M0300A1_1 Asmt Number 1 1263-1263 Number of Stage 1 pressure injuries: Admission
M0300A1_2 M0300A1_2 Asmt Number 1 1264-1264 Number of Stage 1 pressure injuries: Discharge
M0300B1_1 M0300B1_1 Asmt Number 1 1267-1267 Number of Stage 2 pressure ulcers: Admission
M0300B1_2 M0300B1_2 Asmt Number 1 1268-1268 Number of Stage 2 pressure ulcers: Discharge
M0300B2_2 M0300B2_2 Asmt Number 1 1269-1269 Nbr Disch Stg 2 PU were Adm Stg 2 PU
M0300C1_1 M0300C1_1 Asmt Number 1 1272-1272 Number of Stage 3 pressure ulcers: Admission
M0300C1_2 M0300C1_2 Asmt Number 1 1273-1273 Number of Stage 3 pressure ulcers: Discharge
M0300C2_2 M0300C2_2 Asmt Number 1 1274-1274 Nbr Disch Stg 3 PU were Adm Stg 3 PU
M0300D1_1 M0300D1_1 Asmt Number 1 1277-1277 Number of Stage 4 pressure ulcers: Admission
M0300D1_2 M0300D1_2 Asmt Number 1 1278-1278 Number of Stage 4 pressure ulcers: Discharge
M0300D2_2 M0300D2_2 Asmt Number 1 1279-1279 Nbr Disch Stg 4 PU were Adm Stg 4 PU
M0300E1_1 M0300E1_1 Asmt Number 1 1282-1282 Nbr Unstg non-remov drsg prss ulcers/injrs: Adm
M0300E1_2 M0300E1_2 Asmt Number 1 1283-1283 Nbr Unstg non-remov drsg prss ulcers/injrs: Dschrg
M0300E2_2 M0300E2_2 Asmt Number 1 1284-1284 Nbr Unstg NRD Disch PU/Injrs present at Adm
M0300F1_1 M0300F1_1 Asmt Number 1 1286-1286 Nbr Unstg slough/eschar pressure ulcers: Adm
M0300F1_2 M0300F1_2 Asmt Number 1 1287-1287 Nbr Unstg slough/eschar pressure ulcers: Dschrg
M0300F2_2 M0300F2_2 Asmt Number 1 1288-1288 Nbr Unstg S/E Disch PU were Adm Unstg S/E PU
M0300G1_1 M0300G1_1 Asmt Number 1 1290-1290 Nbr Unstg DTI pressure injrs: Adm
M0300G1_2 M0300G1_2 Asmt Number 1 1291-1291 Nbr Unstg DTI pressure injrs: Dschrg
M0300G2_2 M0300G2_2 Asmt Number 1 1292-1292 Nbr Unstg DTI Disch PU/Injrs present at Adm
N0415A1_1 N0415A1_1 Asmt Checklist 1 1780-1780 High-Risk Drug (Is Taking): Antipsychotic
N0415A2_1 N0415A2_1 Asmt Checklist 1 1781-1781 High-Risk Drug (Indication) : Antipsychotic
N0415A1_2 N0415A1_2 Asmt Checklist 1 1782-1782 High-Risk Drug (Is Taking): Antipsychotic
N0415A2_2 N0415A2_2 Asmt Checklist 1 1783-1783 High-Risk Drug (Indication) : Antipsychotic
N0415E1_1 N0415E1_1 Asmt Checklist 1 1784-1784 High-Risk Drug (Is taking): Anticoagulant
N0415E2_1 N0415E2_1 Asmt Checklist 1 1785-1785 High-Risk Drug (Indication): Anticoagulant
N0415E1_2 N0415E1_2 Asmt Checklist 1 1786-1786 High-Risk Drug (Is taking): Anticoagulant
N0415E2_2 N0415E2_2 Asmt Checklist 1 1787-1787 High-Risk Drug (Indication): Anticoagulant
N0415F1_1 N0415F1_1 Asmt Checklist 1 1788-1788 High-Risk Drug (Is taking): Antibiotic
N0415F2_1 N0415F2_1 Asmt Checklist 1 1789-1789 High-Risk Drug (Indication): Antibiotic
N0415F1_2 N0415F1_2 Asmt Checklist 1 1790-1790 High-Risk Drug (Is taking): Antibiotic
N0415F2_2 N0415F2_2 Asmt Checklist 1 1791-1791 High-Risk Drug (Indication): Antibiotic
N0415H1_1 N0415H1_1 Asmt Checklist 1 1792-1792 High-Risk Drug (Is taking): Opioid
N0415H2_1 N0415H2_1 Asmt Checklist 1 1793-1793 High-Drug Risk (Indication): Opioid
N0415H1_2 N0415H1_2 Asmt Checklist 1 1794-1794 High-Risk Drug (Is taking): Opioid
N0415H2_2 N0415H2_2 Asmt Checklist 1 1795-1795 High-Drug Risk (Indication): Opioid
N0415I1_1 N0415I1_1 Asmt Checklist 1 1796-1796 High-Risk Drug (Is taking): Antiplatelet
N0415I2_1 N0415I2_1 Asmt Checklist 1 1797-1797 High-Risk Drug (Indication): Antiplatelet
N0415I1_2 N0415I1_2 Asmt Checklist 1 1798-1798 High-Risk Drug (Is taking): Antiplatelet
N0415I2_2 N0415I2_2 Asmt Checklist 1 1799-1799 High-Risk Drug (Indication): Antiplatelet
N0415J1_1 N0415J1_1 Asmt Checklist 1 1800-1800 High-Risk Drug (Is taking): Hypoglycemic
N0415J2_1 N0415J2_1 Asmt Checklist 1 1801-1801 High-Risk Drug (Indication): Hypoglycemic
N0415J1_2 N0415J1_2 Asmt Checklist 1 1802-1802 High-Risk Drug (Is taking): Hypoglycemic
N0415J2_2 N0415J2_2 Asmt Checklist 1 1803-1803 High-Risk Drug (Indication): Hypoglycemic
N0415Z1_1 N0415Z1_1 Asmt Checklist 1 1804-1804 High-Risk Drug (Is taking): None of the above
N0415Z1_2 N0415Z1_2 Asmt Checklist 1 1805-1805 High-Risk Drug (Is taking): None of the above
N2001 N2001 Asmt Code 1 1645-1645 Drug Regimen Review
N2003 N2003 Asmt Code 1 1646-1646 Medication Follow-up
N2005 N2005 Asmt Code 1 1647-1647 Medication Intervention
O0110A1a O0110A1a Asmt Checklist 1 1806-1806 Treatment: Chemotherapy (Admission)
O0110A1c O0110A1c Asmt Checklist 1 1807-1807 Treatment: Chemotherapy (Discharge)
O0110A2a O0110A2a Asmt Checklist 1 1808-1808 Treatment: IV (Admission)
O0110A2c O0110A2c Asmt Checklist 1 1809-1809 Treatment: IV (Discharge)
O0110A3a O0110A3a Asmt Checklist 1 1810-1810 Treatment: Oral (Admission)
O0110A3c O0110A3c Asmt Checklist 1 1811-1811 Treatment: Oral (Discharge)
O0110A10a O0110A10a Asmt Checklist 1 1812-1812 Treatment: Other (Admission)
O0110A10c O0110A10c Asmt Checklist 1 1813-1813 Treatment: Other (Discharge)
O0110B1a O0110B1a Asmt Checklist 1 1814-1814 Treatment: Radiation (Admission)
O0110B1c O0110B1c Asmt Checklist 1 1815-1815 Treatment: Radiation (Discharge)
O0110C1a O0110C1a Asmt Checklist 1 1816-1816 Therapies: Oxygen Therapy (Admission)
O0110C1c O0110C1c Asmt Checklist 1 1817-1817 Therapies: Oxygen Therapy (Discharge)
O0110C2a O0110C2a Asmt Checklist 1 1818-1818 Therapies: Continuous (Admission)
O0110C2c O0110C2c Asmt Checklist 1 1819-1819 Therapies: Continuous (Discharge)
O0110C3a O0110C3a Asmt Checklist 1 1820-1820 Therapies: Intermittent (Admission)
O0110C3c O0110C3c Asmt Checklist 1 1821-1821 Therapies: Intermittent (Discharge)
O0110C4a O0110C4a Asmt Checklist 1 1822-1822 Therapies: High-concentration (Admission)
O0110C4c O0110C4c Asmt Checklist 1 1823-1823 Therapies: High-concentration (Discharge)
O0110D1a O0110D1a Asmt Checklist 1 1824-1824 Therapies: Suctioning (Admission)
O0110D1c O0110D1c Asmt Checklist 1 1825-1825 Therapies: Suctioning (Discharge)
O0110D2a O0110D2a Asmt Checklist 1 1826-1826 Therapies: Scheduled
O0110D2c O0110D2c Asmt Checklist 1 1827-1827 Therapies: Scheduled (Discharge)
O0110D3a O0110D3a Asmt Checklist 1 1828-1828 Therapies: As Needed (Admission)
O0110D3c O0110D3c Asmt Checklist 1 1829-1829 Therapies: As Needed (Discharge)
O0110E1a O0110E1a Asmt Checklist 1 1830-1830 Therapies: Tracheostomy Care (Admission)
O0110E1c O0110E1c Asmt Checklist 1 1831-1831 Therapies: Tracheostomy Care (Discharge)
O0110F1a O0110F1a Asmt Checklist 1 2798-2798 Therapies: Invasive Mechanical Ventilator (Admis)
O0110F1c O0110F1c Asmt Checklist 1 1832-1832 Therapies: Invasive Mechanical Ventilator (Disch)
O0110G1a O0110G1a Asmt Checklist 1 1833-1833 Therapies: Non-Invas Mechanical Ventilator (Admis)
O0110G1c O0110G1c Asmt Checklist 1 1834-1834 Therapies: Non-Invas Mechanical Ventilator (Disch)
O0110G2a O0110G2a Asmt Checklist 1 1835-1835 Therapies: BiPAP (Admission)
O0110G2c O0110G2c Asmt Checklist 1 1836-1836 Therapies: BiPAP (Discharge)
O0110G3a O0110G3a Asmt Checklist 1 1837-1837 Therapies: CPAP (Admission)
O0110G3c O0110G3c Asmt Checklist 1 1838-1838 Therapies: CPAP (Discharge)
O0110H1a O0110H1a Asmt Checklist 1 1839-1839 Other: IV Medications (Admission)
O0110H1c O0110H1c Asmt Checklist 1 1840-1840 Other: IV Medications (Discharge)
O0110H2a O0110H2a Asmt Checklist 1 1841-1841 Other: Vasoactive medications (Admission)
O0110H2c O0110H2c Asmt Checklist 1 1842-1842 Other: Vasoactive medications (Discharge)
O0110H3a O0110H3a Asmt Checklist 1 1843-1843 Other: Antibiotics (Admission)
O0110H3c O0110H3c Asmt Checklist 1 1844-1844 Other: Antibiotics (Discharge)
O0110H4a O0110H4a Asmt Checklist 1 1845-1845 Other: Anticoagulation (Admission)
O0110H4c O0110H4c Asmt Checklist 1 1846-1846 Other: Anticoagulation (Discharge)
O0110H10a O0110H10a Asmt Checklist 1 1847-1847 Other: Other (Admission)
O0110H10c O0110H10c Asmt Checklist 1 1848-1848 Other: Other (Discharge)
O0110I1a O0110I1a Asmt Checklist 1 1849-1849 Other: Transfusions (Admission)
O0110I1c O0110J1a Asmt Checklist 1 1850-1850 Other: Transfusions (Discharge)
O0110J1a O0110J1a Asmt Checklist 1 1851-1851 Other: Dialysis (Admission)
O0110J1c O0110J1c Asmt Checklist 1 1852-1852 Other: Dialysis (Discharge)
O0110J2a O0110J2a Asmt Checklist 1 1853-1853 Other: Hemodialysis (Admission)
O0110J2c O0110J2c Asmt Checklist 1 1854-1854 Other: Hemodialysis (Discharge)
O0110J3a O0110J3a Asmt Checklist 1 1855-1855 Other: Peritoneal dialysis (Admission)
O0110J3c O0110J3c Asmt Checklist 1 1856-1856 Other: Peritoneal dialysis (Discharge)
O0110O1a O0110O1a Asmt Checklist 1 1857-1857 Other: IV Access (Admission)
O0110O1c O0110O1c Asmt Checklist 1 1858-1858 Other: IV Access (Discharge)
O0110O2a O0110O2a Asmt Checklist 1 1859-1859 Other: Peripheral (Admission)
O0110O2c O0110O2c Asmt Checklist 1 1860-1860 Other: Peripheral (Discharge)
O0110O3a O0110O3a Asmt Checklist 1 1861-1861 Other: Midline (Admission)
O0110O3c O0110O3c Asmt Checklist 1 1862-1862 Other: Midline (Discharge)
O0110O4a O0110O4a Asmt Checklist 1 1863-1863 Other: Central (Admission)
O0110O4c O0110O4c Asmt Checklist 1 1864-1864 Other: Central (Discharge)
O0110Z1a O0110Z1a Asmt Checklist 1 1865-1865 Other: None of the above (Admission)
O0110Z1c O0110Z1c Asmt Checklist 1 1866-1866 Other: None of the above (Discharge)
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Filler - M0900C FILLER_M0900C Filler Text 1 1295-1295 Filler for deleted item
Filler - M0900D FILLER_M0900D Filler Text 1 1296-1296 Filler for deleted item
Filler - 29A FILLER_29A Filler Text 2 842-843 Filler for deleted item
Filler - 29D FILLER_29D Filler Text 2 844-845 Filler for deleted item
Filler - 30A FILLER_30A Filler Text 2 846-847 Filler for deleted item
Filler - 30D FILLER_30D Filler Text 2 848-849 Filler for deleted item
Filler - 31A FILLER_31A Filler Text 2 850-851 Filler for deleted item
Filler - 31D FILLER_31D Filler Text 2 852-853 Filler for deleted item
Filler - 32A FILLER_32A Filler Text 2 854-855 Filler for deleted item
Filler - 32D FILLER_32D Filler Text 2 856-857 Filler for deleted item
Filler - 33A FILLER_33A Filler Text 2 858-859 Filler for deleted item
Filler - 33D FILLER_33D Filler Text 2 860-861 Filler for deleted item
Filler - 34A FILLER_34A Filler Text 2 862-863 Filler for deleted item
Filler - 34D FILLER_34D Filler Text 2 864-865 Filler for deleted item
Filler - 35A FILLER_35A Filler Text 2 866-867 Filler for deleted item
Filler - 35D FILLER_35D Filler Text 2 868-869 Filler for deleted item
Filler - 36A FILLER_36A Filler Text 2 870-871 Filler for deleted item
Filler - 36D FILLER_36D Filler Text 2 872-873 Filler for deleted item
Filler - 37A FILLER_37A Filler Text 2 874-875 Filler for deleted item
Filler - 37D FILLER_37D Filler Text 2 876-877 Filler for deleted item
Filler - 38A FILLER_38A Filler Text 2 878-879 Filler for deleted item
Filler - 38D FILLER_38D Filler Text 2 880-881 Filler for deleted item
Filler - 39AA FILLER_39AA Filler Text 2 882-883 Filler for deleted item
Filler - 39AD FILLER_39AD Filler Text 2 884-885 Filler for deleted item
Filler - 39AG FILLER_39AG Filler Text 2 886-887 Filler for deleted item
Filler - 39BA FILLER_39BA Filler Text 2 888-889 Filler for deleted item
Filler - 39BD FILLER_39BD Filler Text 2 890-891 Filler for deleted item
Filler - 39BG FILLER_39BG Filler Text 2 892-893 Filler for deleted item
Filler - 39CA FILLER_39CA Filler Text 2 894-895 Filler for deleted item
Filler - 39CD FILLER_39CD Filler Text 2 896-897 Filler for deleted item
Filler - 39CG FILLER_39CG Filler Text 2 898-899 Filler for deleted item
Filler - 39DA FILLER_39DA Filler Text 2 900-901 Filler for deleted item
Filler - 39DD FILLER_39DD Filler Text 2 902-903 Filler for deleted item
Filler - 39DG FILLER_39DG Filler Text 2 904-905 Filler for deleted item
Filler - 39EA FILLER_39EA Filler Text 2 906-907 Filler for deleted item
Filler - 39ED FILLER_39ED Filler Text 2 908-909 Filler for deleted item
Filler - 39EG FILLER_39EG Filler Text 2 910-911 Filler for deleted item
Filler - 39FA FILLER_39FA Filler Text 2 912-913 Filler for deleted item
Filler - 39FD FILLER_39FD Filler Text 2 914-915 Filler for deleted item
Filler - 39FG FILLER_39FG Filler Text 2 916-917 Filler for deleted item
Filler - 39GA FILLER_39GA Filler Text 2 918-919 Filler for deleted item
Filler - 39GD FILLER_39GD Filler Text 2 920-921 Filler for deleted item
Filler - 39GG FILLER_39GG Filler Text 2 922-923 Filler for deleted item
Filler - 39HA FILLER_39HA Filler Text 2 924-925 Filler for deleted item
Filler - 39HD FILLER_39HD Filler Text 2 926-927 Filler for deleted item
Filler - 39HG FILLER_39HG Filler Text 2 928-929 Filler for deleted item
Filler - 39IA FILLER_39IA Filler Text 2 930-931 Filler for deleted item
Filler - 39ID FILLER_39ID Filler Text 2 932-933 Filler for deleted item
Filler - 39IG FILLER_39IG Filler Text 2 934-935 Filler for deleted item
Filler - 39JA FILLER_39JA Filler Text 2 936-937 Filler for deleted item
Filler - 39JD FILLER_39JD Filler Text 2 938-939 Filler for deleted item
Filler - 39JG FILLER_39JG Filler Text 2 940-941 Filler for deleted item
Filler - 39KA FILLER_39KA Filler Text 2 942-943 Filler for deleted item
Filler - 39KD FILLER_39KD Filler Text 2 944-945 Filler for deleted item
Filler - 39KG FILLER_39KG Filler Text 2 946-947 Filler for deleted item
Filler - 39LA FILLER_39LA Filler Text 2 948-949 Filler for deleted item
Filler - 39LAA FILLER_39LAA Filler Text 1 950-950 Filler for deleted item
Filler - 39LD FILLER_39LD Filler Text 2 951-952 Filler for deleted item
Filler - 39LDD FILLER_39LDD Filler Text 1 953-953 Filler for deleted item
Filler - 39LG FILLER_39LG Filler Text 2 954-955 Filler for deleted item
Filler - 39MA FILLER_39MA Filler Text 2 956-957 Filler for deleted item
Filler - 39MD FILLER_39MD Filler Text 2 958-959 Filler for deleted item
Filler - 39MG FILLER_39MG Filler Text 2 960-961 Filler for deleted item
Filler - 39NA FILLER_39NA Filler Text 2 962-963 Filler for deleted item
Filler - 39NAA FILLER_39NAA Filler Text 1 964-964 Filler for deleted item
Filler - 39ND FILLER_39ND Filler Text 2 965-966 Filler for deleted item
Filler - 39NDD FILLER_39NDD Filler Text 1 967-967 Filler for deleted item
Filler - 39NG FILLER_39NG Filler Text 2 968-969 Filler for deleted item
Filler - 39OA FILLER_39OA Filler Text 2 970-971 Filler for deleted item
Filler - 39OAA FILLER_39OAA Filler Text 1 972-972 Filler for deleted item
Filler - 39OD FILLER_39OD Filler Text 2 973-974 Filler for deleted item
Filler - 39ODD FILLER_39ODD Filler Text 1 975-975 Filler for deleted item
Filler - 39OG FILLER_39OG Filler Text 2 976-977 Filler for deleted item
Filler - 39PA FILLER_39PA Filler Text 2 978-979 Filler for deleted item
Filler - 39PD FILLER_39PD Filler Text 2 980-981 Filler for deleted item
Filler - 39PG FILLER_39PG Filler Text 2 982-983 Filler for deleted item
Filler - 39QA FILLER_39QA Filler Text 2 984-985 Filler for deleted item
Filler - 39QD FILLER_39QD Filler Text 2 986-987 Filler for deleted item
Filler - 39QG FILLER_39QG Filler Text 2 988-989 Filler for deleted item
Filler - 39RA FILLER_39RA Filler Text 2 990-991 Filler for deleted item
Filler - 39RD FILLER_39RD Filler Text 2 992-993 Filler for deleted item
Filler - 39RG FILLER_39RG Filler Text 2 994-995 Filler for deleted item
Filler - O0250A FILLER_O0250A Filler Text 1 1303-1303 Filler for deleted item
Filler - O0250B FILLER_O0250B Filler Text 8 1304-1311 Filler for deleted item
Filler - O0250C FILLER_O0250C Filler Text 1 1312-1312 Filler for deleted item
ASMT_FILLER ASMT_FILLER Asmt Text 272 1867-2138 Assessment items filler
RCALC_CMG_TXT RCALC_CMG_TXT Calc Text 10 2149-2158 Recalculated CMG Code
RCALC_CMG_VRSN_TXT RCALC_CMG_VRSN_TXT Calc Text 10 2169-2178 Recalculated CMG Version Code
ASSESSMENT_ID ASSESSMENT_ID Calc Number 15 2179-2193 Assessment ID
ORIGINAL_ASSESSMENT_ID ORIGINAL_ASSESSMENT_ID Calc Number 15 2194-2208 Original Assessment ID
RESIDENT_INTERNAL_ID RESIDENT_INTERNAL_ID Calc Number 10 2209-2218 Resident ID
PROVIDER_INTERNAL_ID PROVIDER_INTERNAL_ID Calc Number 10 2219-2228 Provider Internal Number
SUBMISSION_ID SUBMISSION_ID Calc Number 15 2229-2243 Submission ID
SUBMISSION_DATE SUBMISSION_DATE Calc Date 8 2244-2251 Submission Date
SUBMISSION_COMPLETE_DATE SUBMISSION_COMPLETE_DATE Calc Date 8 2252-2259 Submission Complete Date
SUBMITTING_USER_ID SUBMITTING_USER_ID Calc Text 30 2260-2289 Submitting User ID
BIRTHDATE_SUBMIT_CODE BIRTHDATE_SUBMIT_CODE Calc Code 1 2290-2290 Birthdate Submit Code
RESIDENT_MATCH_CRITERIA RESIDENT_MATCH_CRITERIA Calc Number 2 2291-2292 Resident Matching Criteria
RESIDENT_AGE RESIDENT_AGE Calc Number 3 2293-2295 Resident Age
C_MOTOR_SCRE_TXT C_MOTOR_SCRE_TXT Calc Text 5 2296-2300 Calculated Motor Score
C_CGNTV_SCRE_TXT C_CGNTV_SCRE_TXT Calc Text 5 2301-2305 Calculated Cognitive Score
C_CMG_DLL_VRSN_CD C_CMG_DLL_VRSN_CD Calc Text 10 2306-2315 Calculated CMG dll version
C_CCN_NUM C_CCN_NUM Calc Text 12 2316-2327 CMS Certification Number
C_HICN_MBI_IND C_HICN_MBI_IND Calc Text 1 2328-2328 Calculated HICN MBI Indicator
C_SSNRI_TRNSLTN_HICN_TXT C_SSNRI_TRNSLTN_HICN_TXT Calc Text 12 2329-2340 SSNRI Translation HICN Text
C_SSNRI_TRNSLTN_MBI_TXT C_SSNRI_TRNSLTN_MBI_TXT Calc Text 12 2341-2352 SSNRI Translation MBI Text
CALC_FILLER CALC_FILLER Calc Text 443 2353-2795 Calculated items filler
DATA_END_INDICATOR DATA_END_INDICATOR Calc Text 1 2796-2796 End of Data Terminator Code
CR CR Calc Text 1 2797-2797 Carriage Return

NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 03/16/2020 09:31:12 AM