IRF-PAI Item Summary
Item |
XML Tag |
Group |
Type |
Length |
Fixed Start-End |
Description |
ASMT_SYS_CD | ASMT_SYS_CD | Control | Checklist | 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 | 16 | 12-27 | 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 | IRF-PAI Specifications Version |
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 | 2128-2137 | Submitted CMG Code |
SBMTD_CMG_VRSN_TXT | SBMTD_CMG_VRSN_TXT | Control | Text | 10 | 2148-2157 | 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 |
9A | R9A | Asmt | Checklist | 1 | 675-675 | Race: American Indian/Alaskan Native |
9B | R9B | Asmt | Checklist | 1 | 676-676 | Race: Asian |
9C | R9C | Asmt | Checklist | 1 | 677-677 | Race: Black or African American |
9D | R9D | Asmt | Checklist | 1 | 678-678 | Ethnicity: Hispanic or Latino |
9E | R9E | Asmt | Checklist | 1 | 679-679 | Race: Native Hawaiian or other Pacific Islander |
9F | R9F | Asmt | Checklist | 1 | 680-680 | Race: White |
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 |
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 |
27A | R27A | Asmt | Code | 2 | 836-837 | Swallowing Status: Admission |
27D | R27D | Asmt | Code | 2 | 838-839 | Swallowing Status: Discharge |
29A | R29A | Asmt | Code | 2 | 842-843 | Bladder Level of Assistance: Admission |
29D | R29D | Asmt | Code | 2 | 844-845 | Bladder Level of Assistance: Discharge |
30A | R30A | Asmt | Code | 2 | 846-847 | Bladder Frequency of Accidents: Admission |
30D | R30D | Asmt | Code | 2 | 848-849 | Bladder Frequency of Accidents: Discharge |
31A | R31A | Asmt | Code | 2 | 850-851 | Bowel Level of Assistance: Admission |
31D | R31D | Asmt | Code | 2 | 852-853 | Bowel Level of Assistance: Discharge |
32A | R32A | Asmt | Code | 2 | 854-855 | Bowel Frequency of Accidents: Admission |
32D | R32D | Asmt | Code | 2 | 856-857 | Bowel Frequency of Accidents: Discharge |
33A | R33A | Asmt | Code | 2 | 858-859 | Tub Transfer: Admission |
33D | R33D | Asmt | Code | 2 | 860-861 | Tub Transfer: Discharge |
34A | R34A | Asmt | Code | 2 | 862-863 | Shower Transfer: Admission |
34D | R34D | Asmt | Code | 2 | 864-865 | Shower Transfer: Discharge |
35A | R35A | Asmt | Code | 2 | 866-867 | Distance Walked: Admission |
35D | R35D | Asmt | Code | 2 | 868-869 | Distance Walked: Discharge |
36A | R36A | Asmt | Code | 2 | 870-871 | Distance Traveled in Wheelchair: Admission |
36D | R36D | Asmt | Code | 2 | 872-873 | Distance Traveled in Wheelchair: Discharge |
37A | R37A | Asmt | Code | 2 | 874-875 | Walk: Admission |
37D | R37D | Asmt | Code | 2 | 876-877 | Walk: Discharge |
38A | R38A | Asmt | Code | 2 | 878-879 | Wheelchair: Admission |
38D | R38D | Asmt | Code | 2 | 880-881 | Wheelchair: Discharge |
39AA | R39AA | Asmt | Code | 2 | 882-883 | Self-Care -Eating: Admission |
39AD | R39AD | Asmt | Code | 2 | 884-885 | Self-Care -Eating: Discharge |
39AG | R39AG | Asmt | Code | 2 | 886-887 | Self-Care -Eating: Goal |
39BA | R39BA | Asmt | Code | 2 | 888-889 | Self-Care -Grooming: Admission |
39BD | R39BD | Asmt | Code | 2 | 890-891 | Self-Care -Grooming: Discharge |
39BG | R39BG | Asmt | Code | 2 | 892-893 | Self-Care -Grooming: Goal |
39CA | R39CA | Asmt | Code | 2 | 894-895 | Self-Care -Bathing: Admission |
39CD | R39CD | Asmt | Code | 2 | 896-897 | Self-Care -Bathing: Discharge |
39CG | R39CG | Asmt | Code | 2 | 898-899 | Self-Care -Bathing: Goal |
39DA | R39DA | Asmt | Code | 2 | 900-901 | Self-Care -Dressing - Upper: Admission |
39DD | R39DD | Asmt | Code | 2 | 902-903 | Self-Care -Dressing - Upper: Discharge |
39DG | R39DG | Asmt | Code | 2 | 904-905 | Self-Care -Dressing - Upper: Goal |
39EA | R39EA | Asmt | Code | 2 | 906-907 | Self-Care -Dressing - Lower: Admission |
39ED | R39ED | Asmt | Code | 2 | 908-909 | Self-Care -Dressing - Lower: Discharge |
39EG | R39EG | Asmt | Code | 2 | 910-911 | Self-Care -Dressing - Lower: Goal |
39FA | R39FA | Asmt | Code | 2 | 912-913 | Self-Care -Toileting: Admission |
39FD | R39FD | Asmt | Code | 2 | 914-915 | Self-Care -Toileting: Discharge |
39FG | R39FG | Asmt | Code | 2 | 916-917 | Self-Care -Toileting: Goal |
39GA | R39GA | Asmt | Code | 2 | 918-919 | Sphincter Control -Bladder: Admission |
39GD | R39GD | Asmt | Code | 2 | 920-921 | Sphincter Control -Bladder: Discharge |
39GG | R39GG | Asmt | Code | 2 | 922-923 | Sphincter Control -Bladder: Goal |
39HA | R39HA | Asmt | Code | 2 | 924-925 | Sphincter Control -Bowel: Admission |
39HD | R39HD | Asmt | Code | 2 | 926-927 | Sphincter Control -Bowel: Discharge |
39HG | R39HG | Asmt | Code | 2 | 928-929 | Sphincter Control -Bowel: Goal |
39IA | R39IA | Asmt | Code | 2 | 930-931 | Transfers -Bed, Chair, Wheelchair: Admission |
39ID | R39ID | Asmt | Code | 2 | 932-933 | Transfers -Bed, Chair, Wheelchair: Discharge |
39IG | R39IG | Asmt | Code | 2 | 934-935 | Transfers -Bed, Chair, Wheelchair: Goal |
39JA | R39JA | Asmt | Code | 2 | 936-937 | Transfers -Toilet: Admission |
39JD | R39JD | Asmt | Code | 2 | 938-939 | Transfers -Toilet: Discharge |
39JG | R39JG | Asmt | Code | 2 | 940-941 | Transfers -Toilet: Goal |
39KA | R39KA | Asmt | Code | 2 | 942-943 | Transfers -Tub, Shower: Admission |
39KD | R39KD | Asmt | Code | 2 | 944-945 | Transfers - Tub, Shower: Discharge |
39KG | R39KG | Asmt | Code | 2 | 946-947 | Transfers -Tub, Shower: Goal |
39LA | R39LA | Asmt | Code | 2 | 948-949 | Locomotion -Walk/Wheelchair: Admission |
39LAA | R39LAA | Asmt | Code | 1 | 950-950 | Locomotion -Walk/Wheelchair/both: Admission |
39LD | R39LD | Asmt | Code | 2 | 951-952 | Locomotion -Walk/Wheelchair: Discharge |
39LDD | R39LDD | Asmt | Code | 1 | 953-953 | Locomotion -Walk/Wheelchair/both: Discharge |
39LG | R39LG | Asmt | Code | 2 | 954-955 | Locomotion -Walk/Wheelchair: Goal |
39MA | R39MA | Asmt | Code | 2 | 956-957 | Locomotion -Stairs: Admission |
39MD | R39MD | Asmt | Code | 2 | 958-959 | Locomotion -Stairs: Discharge |
39MG | R39MG | Asmt | Code | 2 | 960-961 | Locomotion -Stairs: Goal |
39NA | R39NA | Asmt | Code | 2 | 962-963 | Communication -Comprehension: Admission |
39NAA | R39NAA | Asmt | Code | 1 | 964-964 | Communication -Comp Auditory/Visual/Both:Admission |
39ND | R39ND | Asmt | Code | 2 | 965-966 | Communication -Comprehension: Discharge |
39NDD | R39NDD | Asmt | Code | 1 | 967-967 | Communication -Comp Auditory/Visual/Both:Discharge |
39NG | R39NG | Asmt | Code | 2 | 968-969 | Communication -Comprehension: Goal |
39OA | R39OA | Asmt | Code | 2 | 970-971 | Communication -Expression: Admission |
39OAA | R39OAA | Asmt | Code | 1 | 972-972 | Communication -Expr Vocal/Nonvocal/Both: Admission |
39OD | R39OD | Asmt | Code | 2 | 973-974 | Communication -Expression: Discharge |
39ODD | R39ODD | Asmt | Code | 1 | 975-975 | Communication -Expr Vocal/Nonvocal/Both: Discharge |
39OG | R39OG | Asmt | Code | 2 | 976-977 | Communication -Expression: Goal |
39PA | R39PA | Asmt | Code | 2 | 978-979 | Social Cognition -Social Interaction: Admission |
39PD | R39PD | Asmt | Code | 2 | 980-981 | Social Cognition -Social Interaction: Discharge |
39PG | R39PG | Asmt | Code | 2 | 982-983 | Social Cognition -Social Interaction: Goal |
39QA | R39QA | Asmt | Code | 2 | 984-985 | Social Cognition -Problem Solving: Admission |
39QD | R39QD | Asmt | Code | 2 | 986-987 | Social Cognition -Problem Solving: Discharge |
39QG | R39QG | Asmt | Code | 2 | 988-989 | Social Cognition -Problem Solving: Goal |
39RA | R39RA | Asmt | Code | 2 | 990-991 | Social Cognition -Memory: Admission |
39RD | R39RD | Asmt | Code | 2 | 992-993 | Social Cognition -Memory: Discharge |
39RG | R39RG | Asmt | Code | 2 | 994-995 | Social Cognition -Memory: Goal |
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 |
M0210_1 | M0210_1 | Asmt | Code | 1 | 1261-1261 | Pressure Ulcers Present on Admission |
M0210_2 | M0210_2 | Asmt | Code | 1 | 1262-1262 | Pressure Ulcers Present on Discharge |
M0300A1_1 | M0300A1_1 | Asmt | Number | 1 | 1263-1263 | Number of Stage 1 pressure ulcers: Admission |
M0300A1_2 | M0300A1_2 | Asmt | Number | 1 | 1264-1264 | Number of Stage 1 pressure ulcers: Discharge |
M0300A2_2 | M0300A2_2 | Asmt | Number | 1 | 1265-1265 | Nbr Disch Stg 1 PU were Adm Stg 1 PU |
M0300A3_2 | M0300A3_2 | Asmt | Number | 1 | 1266-1266 | Nbr Disch Stg 1 PU new |
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 |
M0300B3_2 | M0300B3_2 | Asmt | Number | 1 | 1270-1270 | Nbr Disch Stg 2 PU were Adm Unstg PU |
M0300B4_2 | M0300B4_2 | Asmt | Number | 1 | 1271-1271 | Nbr Disch Stg 2 PU new/worsened |
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 |
M0300C3_2 | M0300C3_2 | Asmt | Number | 1 | 1275-1275 | Nbr Disch Stg 3 PU were Adm Unstg PU |
M0300C4_2 | M0300C4_2 | Asmt | Number | 1 | 1276-1276 | Nbr Disch Stg 3 PU new/worsened |
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 |
M0300D3_2 | M0300D3_2 | Asmt | Number | 1 | 1280-1280 | Nbr Disch Stg 4 PU were Adm Unstg PU |
M0300D4_2 | M0300D4_2 | Asmt | Number | 1 | 1281-1281 | Nbr Disch Stg 4 PU new/worsened |
M0300E1_1 | M0300E1_1 | Asmt | Number | 1 | 1282-1282 | Nbr Unstg non-remov drsg pressure ulcers: Adm |
M0300E1_2 | M0300E1_2 | Asmt | Number | 1 | 1283-1283 | Nbr Unstg non-remov drsg pressure ulcers: Dschrg |
M0300E2_2 | M0300E2_2 | Asmt | Number | 1 | 1284-1284 | Nbr Unstg NRD Disch PU were Adm Unstg NRD PU |
M0300E3_2 | M0300E3_2 | Asmt | Number | 1 | 1285-1285 | Nbr Unstg NRD Disch PU were Adm Stageable PU |
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 |
M0300F3_2 | M0300F3_2 | Asmt | Number | 1 | 1289-1289 | Nbr Unstg S/E Disch PU were Adm Stageable PU |
M0300G1_1 | M0300G1_1 | Asmt | Number | 1 | 1290-1290 | Nbr Unstg DTI pressure ulcers: Adm |
M0300G1_2 | M0300G1_2 | Asmt | Number | 1 | 1291-1291 | Nbr Unstg DTI pressure ulcers: Dschrg |
M0300G2_2 | M0300G2_2 | Asmt | Number | 1 | 1292-1292 | Nbr Unstg DTI Disch PU were Adm Unstg DTI PU |
M0900A | M0900A | Asmt | Number | 1 | 1293-1293 | Number of Stage 1 Healed Pressure Ulcers |
M0900B | M0900B | Asmt | Number | 1 | 1294-1294 | Number of Stage 2 Healed Pressure Ulcers |
M0900C | M0900C | Asmt | Number | 1 | 1295-1295 | Number of Stage 3 Healed Pressure Ulcers |
M0900D | M0900D | Asmt | Number | 1 | 1296-1296 | Number of Stage 4 Healed Pressure Ulcers |
I0900A | I0900A | Asmt | Code | 1 | 1297-1297 | Peripheral Vascular Disease (PVD) |
I0900B | I0900B | Asmt | Code | 1 | 1298-1298 | Peripheral Arterial Disease ( PAD) |
I2900A | I2900A | Asmt | Code | 1 | 1299-1299 | Diabetes Mellitus (DM) |
I2900B | I2900B | Asmt | Code | 1 | 1300-1300 | Diabetic Retinopathy |
I2900C | I2900C | Asmt | Code | 1 | 1301-1301 | Diabetic Nephropathy |
I2900D | I2900D | Asmt | Code | 1 | 1302-1302 | Diabetic Neuropathy |
O0250A | O0250A | Asmt | Code | 1 | 1303-1303 | Was influenza vaccine received |
O0250B | O0250B | Asmt | Date | 8 | 1304-1311 | Date influenza vaccine received |
O0250C | O0250C | Asmt | Code | 1 | 1312-1312 | If influenza vaccine not received, state reason |
Filler - 15 | FILLER_15 | Filler | Text | 2 | 706-707 | Prior v1.10 Admit From |
Filler - 16 | FILLER_16 | Filler | Text | 2 | 708-709 | Prior v1.10 Pre-Hospital Living Setting |
Filler - 18 | FILLER_18 | Filler | Text | 2 | 712-713 | Prior v1.10 Pre-Hospital Vocational Category |
Filler - 19 | FILLER_19 | Filler | Text | 2 | 714-715 | Prior v1.10 Pre-Hospital Vocational Effort |
Filler - 22 | R22 | Filler | Text | 8 | 738-745 | Prior V1.11 Etiologic Diagnosis Code A (ICD Code) |
Filler - 25 | FILLER_25 | Filler | Text | 1 | 834-834 | Prior v1.10 Comatose: Admission |
Filler - 26 | FILLER_26 | Filler | Text | 1 | 835-835 | Prior v1.10 Delirious: Admission |
Filler - 28A | FILLER_28A | Filler | Text | 1 | 840-840 | Prior v1.10 Clinical Signs of Dehydration: Adm |
Filler - 28D | FILLER_28D | Filler | Text | 1 | 841-841 | Prior v1.10 Clinical Signs of Dehydration: Disch |
Filler - 44A | FILLER_44D | Filler | Text | 2 | 1054-1055 | Prior v1.10 Discharge to Living Setting |
Filler - 44B | FILLER_44B | Filler | Text | 1 | 1056-1056 | Prior v1.10 Patient Dschrgd with HH Services |
Filler - 48AA | FILLER_48AA | Filler | Text | 1 | 1115-1115 | Filler for deleted item |
Filler - 48AD | FILLER_48AD | Filler | Text | 1 | 1116-1116 | Filler for deleted item |
Filler - 48BA | FILLER_48BA | Filler | Text | 1 | 1117-1117 | Filler for deleted item |
Filler - 48BD | FILLER_48BD | Filler | Text | 1 | 1118-1118 | Filler for deleted item |
Filler - 48CA | FILLER_48CA | Filler | Text | 1 | 1119-1119 | Filler for deleted item |
Filler - 48CD | FILLER_48CD | Filler | Text | 1 | 1120-1120 | Filler for deleted item |
Filler - 49A | FILLER_49A | Filler | Text | 1 | 1121-1121 | Filler for deleted item |
Filler - 49B | FILLER_49B | Filler | Text | 1 | 1122-1122 | Filler for deleted item |
Filler - 49C | FILLER_49C | Filler | Text | 1 | 1123-1123 | Filler for deleted item |
Filler - 50A | FILLER_50A | Filler | Text | 1 | 1124-1124 | Filler for deleted item |
Filler - 50B | FILLER_50B | Filler | Text | 1 | 1125-1125 | Filler for deleted item |
Filler - 50C | FILLER_50C | Filler | Text | 1 | 1126-1126 | Filler for deleted item |
Filler - 50D | FILLER_50d | Filler | Text | 1 | 1127-1127 | Filler for deleted item |
FILLER-44C_LNGTH | FILLER_44C_LNGTH | Filler | Text | 1 | 1258-1258 | Filler for reduced length |
ASMT_FILLER | ASMT_FILLER | Asmt | Text | 694 | 1434-2127 | Assessment items filler |
RCALC_CMG_TXT | RCALC_CMG_TXT | Calc | Text | 10 | 2138-2147 | Recalculated CMG Code |
RCALC_CMG_VRSN_TXT | RCALC_CMG_VRSN_TXT | Calc | Text | 10 | 2158-2167 | Recalculated CMG Version Code |
ASSESSMENT_ID | ASSESSMENT_ID | Calc | Number | 15 | 2168-2182 | Assessment ID |
ORIGINAL_ASSESSMENT_ID | ORIGINAL_ASSESSMENT_ID | Calc | Number | 15 | 2183-2197 | Original Assessment ID |
RESIDENT_INTERNAL_ID | RESIDENT_INTERNAL_ID | Calc | Number | 10 | 2198-2207 | Resident ID |
PROVIDER_INTERNAL_ID | PROVIDER_INTERNAL_ID | Calc | Number | 10 | 2208-2217 | Provider Internal Number |
SUBMISSION_ID | SUBMISSION_ID | Calc | Number | 15 | 2218-2232 | Submission ID |
SUBMISSION_DATE | SUBMISSION_DATE | Calc | Date | 8 | 2233-2240 | Submission Date |
SUBMISSION_COMPLETE_DATE | SUBMISSION_COMPLETE_DATE | Calc | Date | 8 | 2241-2248 | Submission Complete Date |
SUBMITTING_USER_ID | SUBMITTING_USER_ID | Calc | Text | 30 | 2249-2278 | Submitting User ID |
BIRTHDATE_SUBMIT_CODE | BIRTHDATE_SUBMIT_CODE | Calc | Code | 1 | 2279-2279 | Birthdate Submit Code |
RESIDENT_MATCH_CRITERIA | RESIDENT_MATCH_CRITERIA | Calc | Number | 2 | 2280-2281 | Resident Matching Criteria |
RESIDENT_AGE | RESIDENT_AGE | Calc | Number | 3 | 2282-2284 | Resident Age |
C_MOTOR_SCRE_TXT | C_MOTOR_SCRE_TXT | Calc | Text | 5 | 2285-2289 | Calculated Motor Score |
C_CGNTV_SCRE_TXT | C_CGNTV_SCRE_TXT | Calc | Text | 5 | 2290-2294 | Calculated Cognitive Score |
C_CMG_DLL_VRSN_CD | C_CMG_DLL_VRSN_CD | Calc | Text | 10 | 2295-2304 | Calculated CMG dll version |
C_CCN_NUM | C_CCN_NUM | Calc | Text | 12 | 2305-2316 | CMS Certification Number |
CALC_FILLER | CALC_FILLER | Calc | Text | 468 | 2317-2784 | Calculated items filler |
DATA_END_INDICATOR | DATA_END_INDICATOR | Calc | Text | 1 | 2785-2785 | End of Data Terminator Code |
CR | CR | Calc | Text | 1 | 2786-2786 | Carriage Return |
LF | LF | Calc | Text | 1 | 2787-2787 | Line Feed |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 09/09/2015 03:29:57 PM