-1009
Property | Specification |
Data System | LTCH |
Data Specs | V2.02.0 |
Edit Type | Format |
Severity | Fatal |
Edit Text | Only the code values listed in the "Item Values" table of the Detailed Data Specifications Report may be submitted for this item. |
Version Notes |
Item List | |
Item ID | Description |
ASMT_SYS_CD | Assessment system code |
ITM_SBST_CD | Item subset code |
STATE_CD | Facility"s state postal code |
A0050 | Type of record |
A0200 | Type of provider |
A0250 | Reason for Assessment |
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 |
A1100A | Does the patient need or want an interpreter |
A1200 | Marital status |
A1400A | Payer: Medicare (FFS) |
A1400B | Payer: Medicare (managed care/Part C/Mcr Advant.) |
A1400C | Payer: Medicaid (FFS) |
A1400D | Payer: Medicaid (managed care) |
A1400E | Payer: Workers" compensation |
A1400F | Payer: Title programs |
A1400G | Payer: Other Government |
A1400H | Payer: Private insurance/Medigap |
A1400I | Payer: Private managed care |
A1400J | Payer: Self-pay |
A1400K | Payer: No payor source |
A1400X | Payer: Unknown |
A1400Y | Payer: Other |
A1802 | Admitted from |
A2110 | Discharge location |
A2500 | Were there program interruption(s) during stay |
B0100 | Comatose |
BB0700 | Expression of Ideas and Wants (3-day asmt period) |
BB0800 | Understanding Verbal Content (3-day asmt period) |
C1610A | Acute onset |
C1610B | Fluctuating Course |
C1610C | Inattention |
C1610D | Disorganized Thinking |
C1610E1 | Altered Consc Lvl - Alert |
C1610E2 | Altered Consc Lvl - Vigilant/Lethargic/Stupor/Coma |
GG0100B | Indoor Mobility (Ambulation) |
GG0110A | Manual wheelchair |
GG0110B | Motorized wheelchair or scooter |
GG0110C | Mechanical lift |
GG0110Z | None of the above |
GG0130A1 | Self-Care (Adm Perf) - Eating |
GG0130A2 | Self-Care (Dschg Goal) - Eating |
GG0130A3 | Self-Care (Dschg Perf) - Eating |
GG0130B1 | Self-Care (Adm Perf) - Oral hygiene |
GG0130B2 | Self-Care (Dschg Goal) - Oral hygiene |
GG0130B3 | Self-Care (Dschg Perf) - Oral hygiene |
GG0130C1 | Self-Care (Adm Perf) - Toileting hygiene |
GG0130C2 | Self-Care (Dschg Goal) - Toileting hygiene |
GG0130C3 | Self-Care (Dschg Perf) - Toileting hygiene |
GG0130D1 | Self-Care (Adm Perf) - Wash upper body |
GG0130D2 | Self-Care (Dschg Goal) - Wash upper body |
GG0130D3 | Self-Care (Dschg Perf) - Wash upper body |
GG0170A1 | Func Mobil (Adm Perf) - Roll left and right |
GG0170A2 | Func Mobil (Dschg Goal) - Roll left and right |
GG0170A3 | Func Mobil (Dschg Perf) - Roll left and right |
GG0170B1 | Func Mobil (Adm Perf) - Sit to lying |
GG0170B2 | Func Mobil (Dschg Goal) - Sit to lying |
GG0170B3 | Func Mobil (Dschg Perf) - Sit to lying |
GG0170C1 | Func Mobil (Adm Perf) - Lying to sit on side |
GG0170C2 | Func Mobil (Dschg Goal) - Lying to sitting on side |
GG0170C3 | Func Mobil (Dschg Perf) - Lying to sitting on side |
GG0170D1 | Func Mobil (Adm Perf) - Sit to stand |
GG0170D2 | Func Mobil (Dschg Goal) - Sit to stand |
GG0170D3 | Func Mobil (Dschg Perf) - Sit to stand |
GG0170E1 | Func Mobil (Adm Perf) - Chair/bed-to-chair trans |
GG0170E2 | Func Mobil (Dschg Goal) - Chair/bed-to-chair trans |
GG0170E3 | Func Mobil (Dschg Perf) - Chair/bed-to-chair trans |
GG0170F1 | Func Mobil (Adm Perf) - Toilet transfer |
GG0170F2 | Func Mobil (Dschg Goal) - Toilet transfer |
GG0170F3 | Func Mobil (Dschg Perf) - Toilet transfer |
GG0170H1 | Does the patient walk |
GG0170H3 | Does the patient walk |
GG0170I1 | Func Mobil (Adm Perf) - Walk 10 feet |
GG0170I2 | Func Mobil (Dschg Goal) - Walk 10 feet |
GG0170I3 | Func Mobil (Dschg Perf) - Walk 10 feet |
GG0170J1 | Func Mobil (Adm Perf) - Walk 50 feet w/2 turns |
GG0170J2 | Func Mobil (Dschg Goal) - 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 |
GG0170K2 | Func Mobil (Dschg Goal) - Walk 150 feet |
GG0170K3 | Func Mobil (Dschg Perf) - Walk 150 feet |
GG0170Q1 | Does the patient use a wheelchair/scooter |
GG0170Q3 | Does the patient use a wheelchair/scooter |
GG0170R1 | Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns |
GG0170R2 | Func Mobil (Dschg Goal) - Wheel 50 feet w/2 turns |
GG0170R3 | Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns |
GG0170RR1 | Indicate the type of wheelchair/scooter used |
GG0170RR3 | Indicate the type of wheelchair/scooter used |
GG0170S1 | Func Mobil (Adm Perf) - Wheel 150 feet |
GG0170S2 | Func Mobil (Dschg Goal) - Wheel 150 feet |
GG0170S3 | Func Mobil (Dschg Perf) - Wheel 150 feet |
GG0170SS1 | Indicate the type of wheelchair/scooter used |
GG0170SS3 | Indicate the type of wheelchair/scooter used. |
H0350 | Bladder continence |
H0400 | Bowel continence |
I0050 | Patient primary medical condition |
I0101 | Severe and Metastatic Cancers |
I0900 | Peripheral vascular disease (PVD) or PAD |
I1501 | Chronic Kidney Disease, Stage 5 |
I1502 | Acute Renal Failure |
I2101 | Septicemia, Sepsis, Systemic Inflammatory Response |
I2600 | CNS Infect, Oppor Infect, Bone/Joint/Muscle Infect |
I2900 | Diabetes mellitus (DM) |
I4100 | Major Lower Limb Amputation |
I4501 | Stroke |
I4801 | Dementia |
I4900 | Hemiplegia or Hemiparesis |
I5000 | Paraplegia |
I5101 | Complete Tetraplegia |
I5102 | Incomplete Tetraplegia |
I5110 | Other Spinal Cord Disorder/Injury |
I5200 | Multiple Sclerosis (MS) |
I5250 | Huntington"s Disease |
I5300 | Parkinson"s Disease |
I5450 | Amyotrophic Lateral Sclerosis |
I5460 | Locked-In State |
I5470 | Severe Anoxic Brain Damage, Cerebral Edema |
I5601 | Malnutrition |
I5602 | At Risk for Malnutrition |
I7900 | None of the Above |
J1800 | Any Falls Since Admission |
J1900A | Num Falls Since Admission - No injury |
J1900B | Num Falls Since Admission - Injury (except major) |
J1900C | Num Falls Since Admission - Major injury |
M0210 | Patient has Stage 1 or higher pressure ulcers |
O0100F3 | Invasive Mechanical Ventilator - weaning |
O0100F4 | Invasive Mechanical Ventilator - non-weaning |
O0100G | Non-invasive ventilator (BIPAP, CPAP) |
O0100J | Dialysis |
O0100N | Total Parenteral Nutrition |
O0100Z | None of the above |
O0250A | Was influenza vaccine received |
O0250C | If influenza vaccine not received, state reason |
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Generated: 03/14/2017 11:51:05 PM