MDS Item Summary
Item |
Group |
Type |
Length |
Fixed Start-End |
Description |
ASMT_SYS_CD | Control | Code | 10 | 1-10 | Assessment system code |
ITM_SBST_CD | Control | Code | 3 | 11-13 | Item subset code |
ITM_SET_VRSN_CD | Control | Code | 10 | 14-23 | Item set version code |
SPEC_VRSN_CD | Control | Code | 10 | 24-33 | Specifications version code |
PRODN_TEST_CD | Control | Code | 1 | 34-34 | Production/test indicator |
STATE_CD | Control | Code | 2 | 35-36 | Facility"s state postal code |
FAC_ID | Control | Text | 16 | 37-52 | Assigned facility/provider submission ID |
SFTWR_VNDR_ID | Control | Text | 9 | 53-61 | Software vendor federal employer tax ID |
SFTWR_VNDR_NAME | Control | Text | 30 | 62-91 | Software vendor company name |
SFTWR_VNDR_EMAIL_ADR | Control | Text | 50 | 92-141 | Software vendor email address |
SFTWR_PROD_NAME | Control | Text | 50 | 142-191 | Software product name |
SFTWR_PROD_VRSN_CD | Control | Text | 20 | 192-211 | Software product version code |
FAC_DOC_ID | Control | Text | 20 | 212-231 | Facility document ID |
A0050 | Asmt | Code | 1 | 1216-1216 | Type of transaction (formerly X0100) |
A0100A | Asmt | Text | 10 | 232-241 | Facility National Provider Identifier (NPI) |
A0100B | Asmt | Text | 12 | 242-253 | Facility CMS Certification Number (CCN) |
A0100C | Asmt | Text | 15 | 254-268 | State provider number |
A0200 | Asmt | Code | 1 | 269-269 | Type of provider |
A0310A | Asmt | Code | 2 | 270-271 | Type of assessment: OBRA |
A0310B | Asmt | Code | 2 | 272-273 | Type of assessment: PPS |
A0310C | Asmt | Code | 1 | 274-274 | Type of assessment: OMRA |
A0310D | Asmt | Code | 1 | 275-275 | Swing bed clinical change assessment |
A0310E | Asmt | Code | 1 | 276-276 | First assessment since most recent entry |
A0310F | Asmt | Code | 2 | 277-278 | Entry/discharge reporting |
A0310G | Asmt | Code | 1 | 1439-1439 | Planned/unplanned discharge |
A0310H | Asmt | Code | 1 | 1493-1493 | SNF PPS Part A Discharge (End of Stay) Assessment |
A0410 | Asmt | Code | 1 | 279-279 | Submission requirement |
A0500A | Asmt | Text | 12 | 280-291 | Resident first name |
A0500B | Asmt | Text | 1 | 292-292 | Resident middle initial |
A0500C | Asmt | Text | 18 | 293-310 | Resident last name |
A0500D | Asmt | Text | 3 | 311-313 | Resident name suffix |
A0600A | Asmt | Text | 9 | 314-322 | Social Security Number |
A0600B | Asmt | Text | 12 | 323-334 | Resident Medicare/railroad insurance number |
A0700 | Asmt | Text | 14 | 335-348 | Resident Medicaid number |
A0800 | Asmt | Code | 1 | 350-350 | Gender |
A0900 | Asmt | Date | 8 | 351-358 | Birthdate |
A1000A | Asmt | Checklist | 1 | 359-359 | Ethnicity: American Indian or Alaska Native |
A1000B | Asmt | Checklist | 1 | 360-360 | Ethnicity: Asian |
A1000C | Asmt | Checklist | 1 | 361-361 | Ethnicity: Black or African American |
A1000D | Asmt | Checklist | 1 | 362-362 | Ethnicity: Hispanic or Latino |
A1000E | Asmt | Checklist | 1 | 363-363 | Ethnicity: Native Hawaiian/Pacific Islander |
A1000F | Asmt | Checklist | 1 | 364-364 | Ethnicity: White |
A1100A | Asmt | Code | 1 | 365-365 | Does the resident need or want an interpreter |
A1100B | Asmt | Text | 15 | 366-380 | Preferred language |
A1200 | Asmt | Code | 1 | 381-381 | Marital status |
A1300A | Asmt | Text | 12 | 382-393 | Medical record number |
A1300B | Asmt | Text | 10 | 394-403 | Room number |
A1300C | Asmt | Text | 23 | 404-426 | Name by which resident prefers to be addressed |
A1300D | Asmt | Text | 23 | 427-449 | Lifetime occupation(s) |
A1500 | Asmt | Code | 1 | 450-450 | Resident evaluated by PASRR |
A1510A | Asmt | Checklist | 1 | 1440-1440 | Level II PASRR conditions: Serious Mental Illness |
A1510B | Asmt | Checklist | 1 | 1441-1441 | Level II PASRR conditions: Mental Retardation |
A1510C | Asmt | Checklist | 1 | 1442-1442 | Level II PASRR conditions: Other related condition |
A1550A | Asmt | Checklist | 1 | 451-451 | ID/DD status: Down syndrome |
A1550B | Asmt | Checklist | 1 | 452-452 | ID/DD status: Autism |
A1550C | Asmt | Checklist | 1 | 453-453 | ID/DD status: Epilepsy |
A1550D | Asmt | Checklist | 1 | 454-454 | ID/DD status: other organic ID/DD condition |
A1550E | Asmt | Checklist | 1 | 455-455 | ID/DD status: ID/DD with no organic condition |
A1550Z | Asmt | Checklist | 1 | 456-456 | ID/DD status: none of the above |
A1600 | Asmt | Date | 8 | 457-464 | Entry date (date of admission/reentry in facility) |
A1700 | Asmt | Code | 1 | 465-465 | Type of entry |
A1800 | Asmt | Code | 2 | 466-467 | Entered from |
A1900 | Asmt | Date | 8 | 1485-1492 | Admission date |
A2000 | Asmt | Date | 8 | 468-475 | Discharge date |
A2100 | Asmt | Code | 2 | 476-477 | Discharge status |
A2200 | Asmt | Date | 8 | 478-485 | Previous asmt reference date for signif correction |
A2300 | Asmt | Date | 8 | 486-493 | Assessment reference date |
A2400A | Asmt | Code | 1 | 494-494 | Has resident had Medicare-covered stay |
A2400B | Asmt | Date | 8 | 495-502 | Start date of most recent Medicare stay |
A2400C | Asmt | Date | 8 | 503-510 | End date of most recent Medicare stay |
B0100 | Asmt | Code | 1 | 511-511 | Comatose |
B0200 | Asmt | Code | 1 | 512-512 | Hearing |
B0300 | Asmt | Code | 1 | 513-513 | Hearing aid |
B0600 | Asmt | Code | 1 | 514-514 | Speech clarity |
B0700 | Asmt | Code | 1 | 515-515 | Makes self understood |
B0800 | Asmt | Code | 1 | 516-516 | Ability to understand others |
B1000 | Asmt | Code | 1 | 517-517 | Vision |
B1200 | Asmt | Code | 1 | 518-518 | Corrective lenses |
C0100 | Asmt | Code | 1 | 519-519 | BIMS: should resident interview be conducted |
C0200 | Asmt | Code | 1 | 520-520 | BIMS res interview: repetition of three words |
C0300A | Asmt | Code | 1 | 521-521 | BIMS res interview: able to report correct year |
C0300B | Asmt | Code | 1 | 522-522 | BIMS res interview: able to report correct month |
C0300C | Asmt | Code | 1 | 523-523 | BIMS res interview: can report correct day of week |
C0400A | Asmt | Code | 1 | 524-524 | BIMS res interview: able to recall "sock" |
C0400B | Asmt | Code | 1 | 525-525 | BIMS res interview: able to recall "blue" |
C0400C | Asmt | Code | 1 | 526-526 | BIMS res interview: able to recall "bed" |
C0500 | Asmt | Number | 2 | 527-528 | BIMS res interview: summary score |
C0600 | Asmt | Code | 1 | 529-529 | Staff asmt mental status: conduct asmt |
C0700 | Asmt | Code | 1 | 530-530 | Staff asmt mental status: short-term memory OK |
C0800 | Asmt | Code | 1 | 531-531 | Staff asmt mental status: long-term memory OK |
C0900A | Asmt | Checklist | 1 | 532-532 | Staff asmt mental status: recall current season |
C0900B | Asmt | Checklist | 1 | 533-533 | Staff asmt mental status: recall location of room |
C0900C | Asmt | Checklist | 1 | 534-534 | Staff asmt mental status: recall staff names/faces |
C0900D | Asmt | Checklist | 1 | 535-535 | Staff asmt mental status: recall in nh/hosp sw bed |
C0900Z | Asmt | Checklist | 1 | 536-536 | Staff asmt mental status: none of above recalled |
C1000 | Asmt | Code | 1 | 537-537 | Cognitive skills for daily decision making |
C1310A | Asmt | Code | 1 | 1494-1494 | Acute Onset Mental Status Change |
C1310B | Asmt | Code | 1 | 1495-1495 | Inattention |
C1310C | Asmt | Code | 1 | 1496-1496 | Disorganized thinking |
C1310D | Asmt | Code | 1 | 1497-1497 | Altered level of consciousness |
D0100 | Asmt | Code | 1 | 543-543 | PHQ: should resident mood interview be conducted |
D0200A1 | Asmt | Code | 1 | 544-544 | PHQ res: little interest or pleasure - presence |
D0200A2 | Asmt | Code | 1 | 545-545 | PHQ res: little interest or pleasure - frequency |
D0200B1 | Asmt | Code | 1 | 546-546 | PHQ res: feeling down, depressed - presence |
D0200B2 | Asmt | Code | 1 | 547-547 | PHQ res: feeling down, depressed - frequency |
D0200C1 | Asmt | Code | 1 | 548-548 | PHQ res: trouble with sleep - presence |
D0200C2 | Asmt | Code | 1 | 549-549 | PHQ res: trouble with sleep - frequency |
D0200D1 | Asmt | Code | 1 | 550-550 | PHQ res: feeling tired/little energy - presence |
D0200D2 | Asmt | Code | 1 | 551-551 | PHQ res: feeling tired/little energy - frequency |
D0200E1 | Asmt | Code | 1 | 552-552 | PHQ res: poor appetite or overeating - presence |
D0200E2 | Asmt | Code | 1 | 553-553 | PHQ res: poor appetite or overeating - frequency |
D0200F1 | Asmt | Code | 1 | 554-554 | PHQ res: feeling bad about self - presence |
D0200F2 | Asmt | Code | 1 | 555-555 | PHQ res: feeling bad about self - frequency |
D0200G1 | Asmt | Code | 1 | 556-556 | PHQ res: trouble concentrating - presence |
D0200G2 | Asmt | Code | 1 | 557-557 | PHQ res: trouble concentrating - frequency |
D0200H1 | Asmt | Code | 1 | 558-558 | PHQ res: slow, fidgety, restless - presence |
D0200H2 | Asmt | Code | 1 | 559-559 | PHQ res: slow, fidgety, restless - frequency |
D0200I1 | Asmt | Code | 1 | 560-560 | PHQ res: thoughts better off dead - presence |
D0200I2 | Asmt | Code | 1 | 561-561 | PHQ res: thoughts better off dead - frequency |
D0300 | Asmt | Number | 2 | 562-563 | PHQ res: total mood severity score |
D0350 | Asmt | Code | 1 | 564-564 | PHQ res: safety notification |
D0500A1 | Asmt | Code | 1 | 565-565 | PHQ staff: little interest or pleasure - presence |
D0500A2 | Asmt | Code | 1 | 566-566 | PHQ staff: little interest or pleasure - frequency |
D0500B1 | Asmt | Code | 1 | 567-567 | PHQ staff: feeling down, depressed - presence |
D0500B2 | Asmt | Code | 1 | 568-568 | PHQ staff: feeling down, depressed - frequency |
D0500C1 | Asmt | Code | 1 | 569-569 | PHQ staff: trouble with sleep - presence |
D0500C2 | Asmt | Code | 1 | 570-570 | PHQ staff: trouble with sleep - frequency |
D0500D1 | Asmt | Code | 1 | 571-571 | PHQ staff: feeling tired/little energy - presence |
D0500D2 | Asmt | Code | 1 | 572-572 | PHQ staff: feeling tired/little energy - frequency |
D0500E1 | Asmt | Code | 1 | 573-573 | PHQ staff: poor appetite or overeating - presence |
D0500E2 | Asmt | Code | 1 | 574-574 | PHQ staff: poor appetite or overeating - frequency |
D0500F1 | Asmt | Code | 1 | 575-575 | PHQ staff: feeling bad about self - presence |
D0500F2 | Asmt | Code | 1 | 576-576 | PHQ staff: feeling bad about self - frequency |
D0500G1 | Asmt | Code | 1 | 577-577 | PHQ staff: trouble concentrating - presence |
D0500G2 | Asmt | Code | 1 | 578-578 | PHQ staff: trouble concentrating - frequency |
D0500H1 | Asmt | Code | 1 | 579-579 | PHQ staff: slow, fidgety, restless - presence |
D0500H2 | Asmt | Code | 1 | 580-580 | PHQ staff: slow, fidgety, restless - frequency |
D0500I1 | Asmt | Code | 1 | 581-581 | PHQ staff: thoughts better off dead - presence |
D0500I2 | Asmt | Code | 1 | 582-582 | PHQ staff: thoughts better off dead - frequency |
D0500J1 | Asmt | Code | 1 | 583-583 | PHQ staff: short-tempered - presence |
D0500J2 | Asmt | Code | 1 | 584-584 | PHQ staff: short-tempered - frequency |
D0600 | Asmt | Number | 2 | 585-586 | PHQ staff: total mood score |
D0650 | Asmt | Code | 1 | 587-587 | PHQ staff: safety notification |
E0100A | Asmt | Checklist | 1 | 588-588 | Psychosis: hallucinations |
E0100B | Asmt | Checklist | 1 | 589-589 | Psychosis: delusions |
E0100Z | Asmt | Checklist | 1 | 590-590 | Psychosis: none of the above |
E0200A | Asmt | Code | 1 | 591-591 | Physical behav symptoms directed toward others |
E0200B | Asmt | Code | 1 | 592-592 | Verbal behav symptoms directed toward others |
E0200C | Asmt | Code | 1 | 593-593 | Other behav symptoms not directed toward others |
E0300 | Asmt | Code | 1 | 594-594 | Overall presence of behavioral symptoms |
E0500A | Asmt | Code | 1 | 595-595 | Behav symptoms put res at risk for illness/injury |
E0500B | Asmt | Code | 1 | 596-596 | Behav symptoms interfere with resident care |
E0500C | Asmt | Code | 1 | 597-597 | Behav symptoms interfere with social activities |
E0600A | Asmt | Code | 1 | 598-598 | Behav symptoms put others at risk for injury |
E0600B | Asmt | Code | 1 | 599-599 | Behav symptoms intrude on privacy of others |
E0600C | Asmt | Code | 1 | 600-600 | Behav symptoms disrupt care or living environment |
E0800 | Asmt | Code | 1 | 601-601 | Rejection of care: presence and frequency |
E0900 | Asmt | Code | 1 | 602-602 | Wandering: presence and frequency |
E1000A | Asmt | Code | 1 | 603-603 | Wandering: risk of getting to dangerous place |
E1000B | Asmt | Code | 1 | 604-604 | Wandering: intrude on privacy of others |
E1100 | Asmt | Code | 1 | 605-605 | Change in behavioral or other symptoms |
F0300 | Asmt | Code | 1 | 606-606 | Conduct res interview for daily/activity prefs |
F0400A | Asmt | Code | 1 | 607-607 | Res interview: choose clothes to wear |
F0400B | Asmt | Code | 1 | 608-608 | Res interview: take care of personal belongings |
F0400C | Asmt | Code | 1 | 609-609 | Res interview: choose tub, bath, shower, sponge |
F0400D | Asmt | Code | 1 | 610-610 | Res interview: have snacks between meals |
F0400E | Asmt | Code | 1 | 611-611 | Res interview: choose own bedtime |
F0400F | Asmt | Code | 1 | 612-612 | Res interview: discuss care with family/friend |
F0400G | Asmt | Code | 1 | 613-613 | Res interview: use phone in private |
F0400H | Asmt | Code | 1 | 614-614 | Res interview: lock things to keep them safe |
F0500A | Asmt | Code | 1 | 615-615 | Res interview: have books, newspaper, mags to read |
F0500B | Asmt | Code | 1 | 616-616 | Res interview: listen to music |
F0500C | Asmt | Code | 1 | 617-617 | Res interview: be around animals/pets |
F0500D | Asmt | Code | 1 | 618-618 | Res interview: keep up with news |
F0500E | Asmt | Code | 1 | 619-619 | Res interview: do things with groups of people |
F0500F | Asmt | Code | 1 | 620-620 | Res interview: do favorite activities |
F0500G | Asmt | Code | 1 | 621-621 | Res interview: go outside when good weather |
F0500H | Asmt | Code | 1 | 622-622 | Res interview: participate in religious practices |
F0600 | Asmt | Code | 1 | 623-623 | Primary respondent: daily/activities prefs |
F0700 | Asmt | Code | 1 | 624-624 | Conduct staff assessment for daily/activity prefs |
F0800A | Asmt | Checklist | 1 | 625-625 | Staff assessment: choosing clothes to wear |
F0800B | Asmt | Checklist | 1 | 626-626 | Staff assessment: caring for personal belongings |
F0800C | Asmt | Checklist | 1 | 627-627 | Staff assessment: receiving tub bath |
F0800D | Asmt | Checklist | 1 | 628-628 | Staff assessment: receiving shower |
F0800E | Asmt | Checklist | 1 | 629-629 | Staff assessment: receiving bed bath |
F0800F | Asmt | Checklist | 1 | 630-630 | Staff assessment: receiving sponge bath |
F0800G | Asmt | Checklist | 1 | 631-631 | Staff assessment: snacks between meals |
F0800H | Asmt | Checklist | 1 | 632-632 | Staff assessment: staying up past 8PM |
F0800I | Asmt | Checklist | 1 | 633-633 | Staff assessment: discuss care with family/other |
F0800J | Asmt | Checklist | 1 | 634-634 | Staff assessment: use phone in private |
F0800K | Asmt | Checklist | 1 | 635-635 | Staff assessment: place to lock personal things |
F0800L | Asmt | Checklist | 1 | 636-636 | Staff assessment: reading books, newspapers, mags |
F0800M | Asmt | Checklist | 1 | 637-637 | Staff assessment: listening to music |
F0800N | Asmt | Checklist | 1 | 638-638 | Staff assessment: being around animals/pets |
F0800O | Asmt | Checklist | 1 | 639-639 | Staff assessment: keeping up with news |
F0800P | Asmt | Checklist | 1 | 640-640 | Staff assessment: doing things with groups |
F0800Q | Asmt | Checklist | 1 | 641-641 | Staff assessment: participate favorite activities |
F0800R | Asmt | Checklist | 1 | 642-642 | Staff assessment: spend time away from nursng home |
F0800S | Asmt | Checklist | 1 | 643-643 | Staff assessment: spend time outdoors |
F0800T | Asmt | Checklist | 1 | 644-644 | Staff assessment: participate religious activities |
F0800Z | Asmt | Checklist | 1 | 645-645 | Staff assessment: none of above activities |
G0110A1 | Asmt | Code | 1 | 646-646 | Bed mobility: self-performance |
G0110A2 | Asmt | Code | 1 | 647-647 | Bed mobility: support provided |
G0110B1 | Asmt | Code | 1 | 648-648 | Transfer: self-performance |
G0110B2 | Asmt | Code | 1 | 649-649 | Transfer: support provided |
G0110C1 | Asmt | Code | 1 | 650-650 | Walk in room: self-performance |
G0110C2 | Asmt | Code | 1 | 651-651 | Walk in room: support provided |
G0110D1 | Asmt | Code | 1 | 652-652 | Walk in corridor: self-performance |
G0110D2 | Asmt | Code | 1 | 653-653 | Walk in corridor: support provided |
G0110E1 | Asmt | Code | 1 | 654-654 | Locomotion on unit: self-performance |
G0110E2 | Asmt | Code | 1 | 655-655 | Locomotion on unit: support provided |
G0110F1 | Asmt | Code | 1 | 656-656 | Locomotion off unit: self-performance |
G0110F2 | Asmt | Code | 1 | 657-657 | Locomotion off unit: support provided |
G0110G1 | Asmt | Code | 1 | 658-658 | Dressing: self-performance |
G0110G2 | Asmt | Code | 1 | 659-659 | Dressing: support provided |
G0110H1 | Asmt | Code | 1 | 660-660 | Eating: self-performance |
G0110H2 | Asmt | Code | 1 | 661-661 | Eating: support provided |
G0110I1 | Asmt | Code | 1 | 662-662 | Toilet use: self-performance |
G0110I2 | Asmt | Code | 1 | 663-663 | Toilet use: support provided |
G0110J1 | Asmt | Code | 1 | 664-664 | Personal hygiene: self-performance |
G0110J2 | Asmt | Code | 1 | 665-665 | Personal hygiene: support provided |
G0120A | Asmt | Code | 1 | 666-666 | Bathing: self-performance |
G0120B | Asmt | Code | 1 | 667-667 | Bathing: support provided |
G0300A | Asmt | Code | 1 | 668-668 | Balance: moving from seated to standing position |
G0300B | Asmt | Code | 1 | 669-669 | Balance: walking (with assistive device if used) |
G0300C | Asmt | Code | 1 | 670-670 | Balance: turning around while walking |
G0300D | Asmt | Code | 1 | 671-671 | Balance: moving on and off toilet |
G0300E | Asmt | Code | 1 | 672-672 | Balance: surface-to-surface transfer |
G0400A | Asmt | Code | 1 | 673-673 | ROM limitation: upper extremity |
G0400B | Asmt | Code | 1 | 674-674 | ROM limitation: lower extremity |
G0600A | Asmt | Checklist | 1 | 675-675 | Mobility devices: cane/crutch |
G0600B | Asmt | Checklist | 1 | 676-676 | Mobility devices: walker |
G0600C | Asmt | Checklist | 1 | 677-677 | Mobility devices: wheelchair (manual or electric) |
G0600D | Asmt | Checklist | 1 | 678-678 | Mobility devices: limb prosthesis |
G0600Z | Asmt | Checklist | 1 | 679-679 | Mobility devices: none of the above |
G0900A | Asmt | Code | 1 | 680-680 | Resident believes capable of increased independ |
G0900B | Asmt | Code | 1 | 681-681 | Staff believes res capable of increased independ |
GG0130A1 | Asmt | Code | 2 | 1498-1499 | Eating (Start of Stay Perf) |
GG0130A2 | Asmt | Code | 2 | 1500-1501 | Eating (Dschg Goal) |
GG0130A3 | Asmt | Code | 2 | 1502-1503 | Eating (Dischg Perf) |
GG0130B1 | Asmt | Code | 2 | 1504-1505 | Oral Hygiene (Start of Stay Perf) |
GG0130B2 | Asmt | Code | 2 | 1506-1507 | Oral Hygiene (Dschg Goal) |
GG0130B3 | Asmt | Code | 2 | 1508-1509 | Oral Hygiene (Dschg Perf) |
GG0130C1 | Asmt | Code | 2 | 1510-1511 | Toileting Hygiene (Start of Stay Perf) |
GG0130C2 | Asmt | Code | 2 | 1512-1513 | Toileting Hygiene (Dschg Goal) |
GG0130C3 | Asmt | Code | 2 | 1514-1515 | Toileting Hygiene (Dschg Perf) |
GG0170B1 | Asmt | Code | 2 | 1516-1517 | Sit to lying (Start of Stay Perf) |
GG0170B2 | Asmt | Code | 2 | 1518-1519 | Sit to lying (Dschg Goal) |
GG0170B3 | Asmt | Code | 2 | 1520-1521 | Sit to lying (Dschg Perf) |
GG0170C1 | Asmt | Code | 2 | 1522-1523 | Lying to sitting on bed side (Start of Stay Perf) |
GG0170C2 | Asmt | Code | 2 | 1524-1525 | Lying to sitting on bed side (Dschg Goal) |
GG0170C3 | Asmt | Code | 2 | 1526-1527 | Lying to sitting on bed side (Dschg Perf) |
GG0170D1 | Asmt | Code | 2 | 1528-1529 | Sit to stand (Start of Stay Perf) |
GG0170D2 | Asmt | Code | 2 | 1530-1531 | Sit to stand (Dschg Goal) |
GG0170D3 | Asmt | Code | 2 | 1532-1533 | Sit to stand (Dschg Perf) |
GG0170E1 | Asmt | Code | 2 | 1534-1535 | Chair/bed-to-chair transfer (Start of Stay Perf) |
GG0170E2 | Asmt | Code | 2 | 1536-1537 | Chair/bed-to-chair transfer (Dschg Goal) |
GG0170E3 | Asmt | Code | 2 | 1538-1539 | Chair/bed-to-chair transfer (Dschg Perf) |
GG0170F1 | Asmt | Code | 2 | 1540-1541 | Toilet transfer (Start of Stay Perf) |
GG0170F2 | Asmt | Code | 2 | 1542-1543 | Toilet transfer (Dschg Goal) |
GG0170F3 | Asmt | Code | 2 | 1544-1545 | Toilet transfer (Dschg Perf) |
GG0170H1 | Asmt | Code | 1 | 1546-1546 | Does the resident walk? (Start of Stay Perf) |
GG0170H3 | Asmt | Code | 1 | 1547-1547 | Does the resident walk? (Dschg Perf) |
GG0170J1 | Asmt | Code | 2 | 1548-1549 | Walk 50 feet with two turns (Start of Stay Perf) |
GG0170J2 | Asmt | Code | 2 | 1550-1551 | Walk 50 feet with two turns (Dschg Goal) |
GG0170J3 | Asmt | Code | 2 | 1552-1553 | Walk 50 feet with two turns (Dschg Perf) |
GG0170K1 | Asmt | Code | 2 | 1554-1555 | Walk 150 feet (Start of Stay Perf) |
GG0170K2 | Asmt | Code | 2 | 1556-1557 | Walk 150 feet (Dschg Goal) |
GG0170K3 | Asmt | Code | 2 | 1558-1559 | Walk 150 feet (Dschg Perf) |
GG0170Q1 | Asmt | Code | 1 | 1560-1560 | Use of wheelchair/scooter (Start of Stay Perf) |
GG0170Q3 | Asmt | Code | 1 | 1561-1561 | Use of wheelchair/scooter (Dschg Perf) |
GG0170R1 | Asmt | Code | 2 | 1562-1563 | Wheel 50 feet with two turns (Start of Stay Perf) |
GG0170R2 | Asmt | Code | 2 | 1564-1565 | Wheel 50 feet with two turns (Dschg Goal) |
GG0170R3 | Asmt | Code | 2 | 1566-1567 | Wheel 50 feet with two turns (Dschg Perf) |
GG0170RR1 | Asmt | Code | 1 | 1568-1568 | Type wheelchair/scooter used (Start of Stay Perf) |
GG0170RR3 | Asmt | Code | 1 | 1569-1569 | Type wheelchair/scooter used (Dschg Perf) |
GG0170S1 | Asmt | Code | 2 | 1570-1571 | Wheel 150 feet (Start of Stay Perf) |
GG0170S2 | Asmt | Code | 2 | 1572-1573 | Wheel 150 feet (Dschg Goal) |
GG0170S3 | Asmt | Code | 2 | 1574-1575 | Wheel 150 feet (Dschg Perf) |
GG0170SS1 | Asmt | Code | 1 | 1576-1576 | Type wheelchair/scooter used (Start of Stay Perf) |
GG0170SS3 | Asmt | Code | 1 | 1577-1577 | Type wheelchair/scooter used (Dschg Perf) |
H0100A | Asmt | Checklist | 1 | 682-682 | Appliances: indwelling catheter |
H0100B | Asmt | Checklist | 1 | 683-683 | Appliances: external catheter |
H0100C | Asmt | Checklist | 1 | 684-684 | Appliances: ostomy |
H0100D | Asmt | Checklist | 1 | 685-685 | Appliances: intermittent catheterization |
H0100Z | Asmt | Checklist | 1 | 686-686 | Appliances: none of the above |
H0200A | Asmt | Code | 1 | 687-687 | Urinary toileting program: has been attempted |
H0200B | Asmt | Code | 1 | 688-688 | Urinary toileting program: response |
H0200C | Asmt | Code | 1 | 689-689 | Urinary toileting program: current program/trial |
H0300 | Asmt | Code | 1 | 690-690 | Urinary continence |
H0400 | Asmt | Code | 1 | 691-691 | Bowel continence |
H0500 | Asmt | Code | 1 | 692-692 | Bowel toileting program being used |
H0600 | Asmt | Code | 1 | 693-693 | Constipation |
I0100 | Asmt | Checklist | 1 | 694-694 | Cancer (with or without metastasis) |
I0200 | Asmt | Checklist | 1 | 695-695 | Anemia |
I0300 | Asmt | Checklist | 1 | 696-696 | Atrial fibrillation and other dysrhythmias |
I0400 | Asmt | Checklist | 1 | 697-697 | Coronary artery disease (CAD) |
I0500 | Asmt | Checklist | 1 | 698-698 | Deep venous thrombosis (DVT), PE, or PTE |
I0600 | Asmt | Checklist | 1 | 699-699 | Heart failure |
I0700 | Asmt | Checklist | 1 | 700-700 | Hypertension |
I0800 | Asmt | Checklist | 1 | 701-701 | Orthostatic hypotension |
I0900 | Asmt | Checklist | 1 | 702-702 | Peripheral vascular disease (PVD) or PAD |
I1100 | Asmt | Checklist | 1 | 703-703 | Cirrhosis |
I1200 | Asmt | Checklist | 1 | 704-704 | Gastroesophageal reflux disease (GERD) or ulcer |
I1300 | Asmt | Checklist | 1 | 705-705 | Ulcerative colitis, Chrohn"s, inflam bowel disease |
I1400 | Asmt | Checklist | 1 | 706-706 | Benign prostatic hyperplasia (BPH) |
I1500 | Asmt | Checklist | 1 | 707-707 | Renal insufficiency, renal failure, ESRD |
I1550 | Asmt | Checklist | 1 | 708-708 | Neurogenic bladder |
I1650 | Asmt | Checklist | 1 | 709-709 | Obstructive uropathy |
I1700 | Asmt | Checklist | 1 | 710-710 | Multidrug resistant organism (MDRO) |
I2000 | Asmt | Checklist | 1 | 711-711 | Pneumonia |
I2100 | Asmt | Checklist | 1 | 712-712 | Septicemia |
I2200 | Asmt | Checklist | 1 | 713-713 | Tuberculosis |
I2300 | Asmt | Checklist | 1 | 714-714 | Urinary tract infection (UTI) (LAST 30 DAYS) |
I2400 | Asmt | Checklist | 1 | 715-715 | Viral hepatitis (includes type A, B, C, D, and E) |
I2500 | Asmt | Checklist | 1 | 716-716 | Wound infection (other than foot) |
I2900 | Asmt | Checklist | 1 | 717-717 | Diabetes mellitus (DM) |
I3100 | Asmt | Checklist | 1 | 718-718 | Hyponatremia |
I3200 | Asmt | Checklist | 1 | 719-719 | Hyperkalemia |
I3300 | Asmt | Checklist | 1 | 720-720 | Hyperlipidemia (e.g., hypercholesterolemia) |
I3400 | Asmt | Checklist | 1 | 721-721 | Thyroid disorder |
I3700 | Asmt | Checklist | 1 | 722-722 | Arthritis |
I3800 | Asmt | Checklist | 1 | 723-723 | Osteoporosis |
I3900 | Asmt | Checklist | 1 | 724-724 | Hip fracture |
I4000 | Asmt | Checklist | 1 | 725-725 | Other fracture |
I4200 | Asmt | Checklist | 1 | 726-726 | Alzheimer"s disease |
I4300 | Asmt | Checklist | 1 | 727-727 | Aphasia |
I4400 | Asmt | Checklist | 1 | 728-728 | Cerebral palsy |
I4500 | Asmt | Checklist | 1 | 729-729 | Cerebrovascular accident (CVA), TIA, or stroke |
I4800 | Asmt | Checklist | 1 | 730-730 | Non-Alzheimer"s dementia |
I4900 | Asmt | Checklist | 1 | 731-731 | Hemiplegia or hemiparesis |
I5000 | Asmt | Checklist | 1 | 732-732 | Paraplegia |
I5100 | Asmt | Checklist | 1 | 733-733 | Quadriplegia |
I5200 | Asmt | Checklist | 1 | 734-734 | Multiple sclerosis |
I5250 | Asmt | Checklist | 1 | 735-735 | Huntington"s disease |
I5300 | Asmt | Checklist | 1 | 736-736 | Parkinson"s disease |
I5350 | Asmt | Checklist | 1 | 737-737 | Tourette"s syndrome |
I5400 | Asmt | Checklist | 1 | 738-738 | Seizure disorder or epilepsy |
I5500 | Asmt | Checklist | 1 | 739-739 | Traumatic brain injury (TBI) |
I5600 | Asmt | Checklist | 1 | 740-740 | Malnutrition (protein, calorie), risk of malnutrit |
I5700 | Asmt | Checklist | 1 | 741-741 | Anxiety disorder |
I5800 | Asmt | Checklist | 1 | 742-742 | Depression (other than bipolar) |
I5900 | Asmt | Checklist | 1 | 743-743 | Manic depression (bipolar disease) |
I5950 | Asmt | Checklist | 1 | 744-744 | Psychotic disorder (other than schizophrenia) |
I6000 | Asmt | Checklist | 1 | 745-745 | Schizophrenia |
I6100 | Asmt | Checklist | 1 | 746-746 | Post-traumatic stress disorder (PTSD) |
I6200 | Asmt | Checklist | 1 | 747-747 | Asthma (COPD) or chronic lung disease |
I6300 | Asmt | Checklist | 1 | 748-748 | Respiratory failure |
I6500 | Asmt | Checklist | 1 | 749-749 | Cataracts, glaucoma, or macular degeneration |
I7900 | Asmt | Checklist | 1 | 750-750 | None of above active diseases within last 7 days |
I8000A | Asmt | ICD | 8 | 751-758 | Additional active ICD diagnosis 1 |
I8000B | Asmt | ICD | 8 | 759-766 | Additional active ICD diagnosis 2 |
I8000C | Asmt | ICD | 8 | 767-774 | Additional active ICD diagnosis 3 |
I8000D | Asmt | ICD | 8 | 775-782 | Additional active ICD diagnosis 4 |
I8000E | Asmt | ICD | 8 | 783-790 | Additional active ICD diagnosis 5 |
I8000F | Asmt | ICD | 8 | 791-798 | Additional active ICD diagnosis 6 |
I8000G | Asmt | ICD | 8 | 799-806 | Additional active ICD diagnosis 7 |
I8000H | Asmt | ICD | 8 | 807-814 | Additional active ICD diagnosis 8 |
I8000I | Asmt | ICD | 8 | 815-822 | Additional active ICD diagnosis 9 |
I8000J | Asmt | ICD | 8 | 823-830 | Additional active ICD diagnosis 10 |
J0100A | Asmt | Code | 1 | 831-831 | Pain: received scheduled pain med regimen |
J0100B | Asmt | Code | 1 | 832-832 | Pain: received PRN pain medications |
J0100C | Asmt | Code | 1 | 833-833 | Pain: received non-medication intervention |
J0200 | Asmt | Code | 1 | 834-834 | Should pain assessment interview be conducted |
J0300 | Asmt | Code | 1 | 835-835 | Res pain interview: presence |
J0400 | Asmt | Code | 1 | 836-836 | Res pain interview: frequency |
J0500A | Asmt | Code | 1 | 837-837 | Res pain interview: made it hard to sleep |
J0500B | Asmt | Code | 1 | 838-838 | Res pain interview: limited daily activities |
J0600A | Asmt | Number | 2 | 839-840 | Res pain interview: intensity rating scale |
J0600B | Asmt | Code | 1 | 841-841 | Res pain interview: verbal descriptor scale |
J0700 | Asmt | Code | 1 | 842-842 | Should staff assessment for pain be conducted |
J0800A | Asmt | Checklist | 1 | 843-843 | Staff pain asmt: non-verbal sounds |
J0800B | Asmt | Checklist | 1 | 844-844 | Staff pain asmt: vocal complaints of pain |
J0800C | Asmt | Checklist | 1 | 845-845 | Staff pain asmt: facial expressions |
J0800D | Asmt | Checklist | 1 | 846-846 | Staff pain asmt: protective movements/postures |
J0800Z | Asmt | Checklist | 1 | 847-847 | Staff pain asmt: none of these signs observed |
J0850 | Asmt | Code | 1 | 848-848 | Staff pain asmt: frequency of pain |
J1100A | Asmt | Checklist | 1 | 849-849 | Short breath/trouble breathing: with exertion |
J1100B | Asmt | Checklist | 1 | 850-850 | Short breath/trouble breathing: sitting at rest |
J1100C | Asmt | Checklist | 1 | 851-851 | Short breath/trouble breathing: lying flat |
J1100Z | Asmt | Checklist | 1 | 852-852 | Short breath/trouble breathing: none of above |
J1300 | Asmt | Code | 1 | 853-853 | Current tobacco use |
J1400 | Asmt | Code | 1 | 854-854 | Prognosis: life expectancy of less than 6 months |
J1550A | Asmt | Checklist | 1 | 855-855 | Problem conditions: fever |
J1550B | Asmt | Checklist | 1 | 856-856 | Problem conditions: vomiting |
J1550C | Asmt | Checklist | 1 | 857-857 | Problem conditions: dehydrated |
J1550D | Asmt | Checklist | 1 | 858-858 | Problem conditions: internal bleeding |
J1550Z | Asmt | Checklist | 1 | 859-859 | Problem conditions: none of the above |
J1700A | Asmt | Code | 1 | 860-860 | Fall history: fall during month before admission |
J1700B | Asmt | Code | 1 | 861-861 | Fall history: fall 2-6 months before admission |
J1700C | Asmt | Code | 1 | 862-862 | Fall history: fracture from fall 6 month pre admit |
J1800 | Asmt | Code | 1 | 863-863 | Falls since admit/prior asmt: any falls |
J1900A | Asmt | Code | 1 | 864-864 | Falls since admit/prior asmt: no injury |
J1900B | Asmt | Code | 1 | 865-865 | Falls since admit/prior asmt: injury (not major) |
J1900C | Asmt | Code | 1 | 866-866 | Falls since admit/prior asmt: major injury |
K0100A | Asmt | Checklist | 1 | 867-867 | Swallow disorder: loss liquids/solids from mouth |
K0100B | Asmt | Checklist | 1 | 868-868 | Swallow disorder: holds food in mouth/cheeks |
K0100C | Asmt | Checklist | 1 | 869-869 | Swallow disorder: cough/choke with meals/meds |
K0100D | Asmt | Checklist | 1 | 870-870 | Swallow disorder: difficulty or pain swallowing |
K0100Z | Asmt | Checklist | 1 | 871-871 | Swallow disorder: none of the above |
K0200A | Asmt | Number | 2 | 872-873 | Height (in inches) |
K0200B | Asmt | Number | 3 | 874-876 | Weight (in pounds) |
K0300 | Asmt | Code | 1 | 877-877 | Weight loss |
K0310 | Asmt | Code | 1 | 1443-1443 | Weight Gain |
K0510A1 | Asmt | Checklist | 1 | 1444-1444 | Nutrition approach: Not Res: parenteral/IV feeding |
K0510A2 | Asmt | Checklist | 1 | 1445-1445 | Nutrition approach: Res: parenteral /IV feeding |
K0510B1 | Asmt | Checklist | 1 | 1446-1446 | Nutrition approach: Not Res: feeding tube |
K0510B2 | Asmt | Checklist | 1 | 1447-1447 | Nutrition approach: Res: feeding tube |
K0510C1 | Asmt | Checklist | 1 | 1448-1448 | Nutrition approach: Not Res: mechanic altered diet |
K0510C2 | Asmt | Checklist | 1 | 1449-1449 | Nutrition approach: Res: mechanic altered diet |
K0510D1 | Asmt | Checklist | 1 | 1450-1450 | Nutrition approach: Not Res: therapeutic diet |
K0510D2 | Asmt | Checklist | 1 | 1451-1451 | Nutrition approach: Res: therapeutic diet |
K0510Z1 | Asmt | Checklist | 1 | 1452-1452 | Nutrition approach: Not Res: none of the above |
K0510Z2 | Asmt | Checklist | 1 | 1453-1453 | Nutrition approach: Res: none of the above |
K0710A1 | Asmt | Code | 1 | 1466-1466 | Prop calories parenteral/tube feed: not resident |
K0710A2 | Asmt | Code | 1 | 1467-1467 | Prop calories parenteral/tube feed: while resident |
K0710A3 | Asmt | Code | 1 | 1468-1468 | Prop calories parenteral/tube feed: 7 days |
K0710B1 | Asmt | Code | 1 | 1469-1469 | Avg fluid intake per day IV/tube: not resident |
K0710B2 | Asmt | Code | 1 | 1470-1470 | Avg fluid intake per day IV/ tube: while resident |
K0710B3 | Asmt | Code | 1 | 1471-1471 | Avg fluid intake per day IV/tube: 7 days |
L0200A | Asmt | Checklist | 1 | 885-885 | Dental: broken or loosely fitting denture |
L0200B | Asmt | Checklist | 1 | 886-886 | Dental: no natural teeth or tooth fragment(s) |
L0200C | Asmt | Checklist | 1 | 887-887 | Dental: abnormal mouth tissue |
L0200D | Asmt | Checklist | 1 | 888-888 | Dental: cavity or broken natural teeth |
L0200E | Asmt | Checklist | 1 | 889-889 | Dental: inflamed/bleeding gums or loose teeth |
L0200F | Asmt | Checklist | 1 | 890-890 | Dental: pain, discomfort, difficulty chewing |
L0200G | Asmt | Checklist | 1 | 891-891 | Dental: unable to examine |
L0200Z | Asmt | Checklist | 1 | 892-892 | Dental: none of the above |
M0100A | Asmt | Checklist | 1 | 893-893 | Risk determination: has ulcer, scar, or dressing |
M0100B | Asmt | Checklist | 1 | 894-894 | Risk determination: formal assessment |
M0100C | Asmt | Checklist | 1 | 895-895 | Risk determination: clinical assessment |
M0100Z | Asmt | Checklist | 1 | 896-896 | Risk determination: none of the above |
M0150 | Asmt | Code | 1 | 897-897 | Is resident at risk of developing pressure ulcer |
M0210 | Asmt | Code | 1 | 898-898 | Resident has Stage 1 or higher pressure ulcers |
M0300A | Asmt | Number | 1 | 899-899 | Stage 1 pressure ulcers: number present |
M0300B1 | Asmt | Number | 1 | 900-900 | Stage 2 pressure ulcers: number present |
M0300B2 | Asmt | Number | 1 | 901-901 | Stage 2 pressure ulcers: number at admit/reentry |
M0300B3 | Asmt | Date | 8 | 902-909 | Stage 2 pressure ulcers: date of oldest |
M0300C1 | Asmt | Number | 1 | 910-910 | Stage 3 pressure ulcers: number present |
M0300C2 | Asmt | Number | 1 | 911-911 | Stage 3 pressure ulcers: number at admit/reentry |
M0300D1 | Asmt | Number | 1 | 912-912 | Stage 4 pressure ulcers: number present |
M0300D2 | Asmt | Number | 1 | 913-913 | Stage 4 pressure ulcers: number at admit/reentry |
M0300E1 | Asmt | Number | 1 | 914-914 | Unstaged due to dressing: number present |
M0300E2 | Asmt | Number | 1 | 915-915 | Unstaged due to dressing: number at admit/reentry |
M0300F1 | Asmt | Number | 1 | 916-916 | Unstaged slough/eschar: number present |
M0300F2 | Asmt | Number | 1 | 917-917 | Unstaged slough/eschar: number at admit/reentry |
M0300G1 | Asmt | Number | 1 | 918-918 | Unstageable - deep tissue injury: # present |
M0300G2 | Asmt | Number | 1 | 919-919 | Unstageable - deep tissue injury: # at adm/reent |
M0610A | Asmt | Number | 4 | 920-923 | Stage 3 or 4 pressure ulcer longest length |
M0610B | Asmt | Number | 4 | 924-927 | Stage 3 or 4 pressure ulcer width (same ulcer) |
M0610C | Asmt | Number | 4 | 928-931 | Stage 3 or 4 pressure ulcer depth (same ulcer) |
M0700 | Asmt | Code | 1 | 932-932 | Tissue type for ulcer at most advanced stage |
M0800A | Asmt | Number | 1 | 933-933 | Worsened since prior asmt: Stage 2 pressure ulcers |
M0800B | Asmt | Number | 1 | 934-934 | Worsened since prior asmt: Stage 3 pressure ulcers |
M0800C | Asmt | Number | 1 | 935-935 | Worsened since prior asmt: Stage 4 pressure ulcers |
M0900A | Asmt | Code | 1 | 936-936 | Pressure ulcers on prior assessment |
M0900B | Asmt | Number | 1 | 937-937 | Healed pressure ulcers: Stage 2 |
M0900C | Asmt | Number | 1 | 938-938 | Healed pressure ulcers: Stage 3 |
M0900D | Asmt | Number | 1 | 939-939 | Healed pressure ulcers: Stage 4 |
M1030 | Asmt | Number | 1 | 940-940 | Number of venous and arterial ulcers |
M1040A | Asmt | Checklist | 1 | 941-941 | Other skin probs: infection of the foot |
M1040B | Asmt | Checklist | 1 | 942-942 | Other skin probs: diabetic foot ulcer(s) |
M1040C | Asmt | Checklist | 1 | 943-943 | Other skin probs: other open lesion(s) on the foot |
M1040D | Asmt | Checklist | 1 | 944-944 | Other skin probs: lesions not ulcers, rashes, cuts |
M1040E | Asmt | Checklist | 1 | 945-945 | Other skin probs: surgical wound(s) |
M1040F | Asmt | Checklist | 1 | 946-946 | Other skin probs: burns (second or third degree) |
M1040G | Asmt | Checklist | 1 | 1454-1454 | Skin Tear(s) |
M1040H | Asmt | Checklist | 1 | 1455-1455 | Moisture Associated Skin Damage (MASD) |
M1040Z | Asmt | Checklist | 1 | 947-947 | Other skin probs: none of the above |
M1200A | Asmt | Checklist | 1 | 948-948 | Skin/ulcer treat: pressure reduce device for chair |
M1200B | Asmt | Checklist | 1 | 949-949 | Skin/ulcer treat: pressure reducing device for bed |
M1200C | Asmt | Checklist | 1 | 950-950 | Skin/ulcer treat: turning/repositioning |
M1200D | Asmt | Checklist | 1 | 951-951 | Skin/ulcer treat: nutrition/hydration |
M1200E | Asmt | Checklist | 1 | 952-952 | Skin/ulcer treat: pressure ulcer care |
M1200F | Asmt | Checklist | 1 | 953-953 | Skin/ulcer treat: surgical wound care |
M1200G | Asmt | Checklist | 1 | 954-954 | Skin/ulcer treat: application of dressings |
M1200H | Asmt | Checklist | 1 | 955-955 | Skin/ulcer treat: apply ointments/medications |
M1200I | Asmt | Checklist | 1 | 956-956 | Skin/ulcer treat: apply dressings to feet |
M1200Z | Asmt | Checklist | 1 | 957-957 | Skin/ulcer treat: none of the above |
N0300 | Asmt | Number | 1 | 958-958 | Number of days injectable medications received |
N0350A | Asmt | Number | 1 | 959-959 | Insulin: insulin injections |
N0350B | Asmt | Number | 1 | 960-960 | Insulin: orders for insulin |
N0410A | Asmt | Number | 1 | 1456-1456 | Medication received: Days: antipsychotic |
N0410B | Asmt | Number | 1 | 1457-1457 | Medication received: Days: antianxiety |
N0410C | Asmt | Number | 1 | 1458-1458 | Medication received: Days: antidepressant |
N0410D | Asmt | Number | 1 | 1459-1459 | Medication received: Days: hypnotic |
N0410E | Asmt | Number | 1 | 1460-1460 | Medication received: Days: anticoagulant |
N0410F | Asmt | Number | 1 | 1461-1461 | Medication received: Days: antibiotic |
N0410G | Asmt | Number | 1 | 1462-1462 | Medication received: Days: diuretic |
O0100A1 | Asmt | Checklist | 1 | 969-969 | Treatment: chemotherapy - while not resident |
O0100A2 | Asmt | Checklist | 1 | 970-970 | Treatment: chemotherapy - while resident |
O0100B1 | Asmt | Checklist | 1 | 971-971 | Treatment: radiation - while not resident |
O0100B2 | Asmt | Checklist | 1 | 972-972 | Treatment: radiation - while resident |
O0100C1 | Asmt | Checklist | 1 | 973-973 | Treatment: oxygen therapy - while not resident |
O0100C2 | Asmt | Checklist | 1 | 974-974 | Treatment: oxygen therapy - while resident |
O0100D1 | Asmt | Checklist | 1 | 975-975 | Treatment: suctioning - while not resident |
O0100D2 | Asmt | Checklist | 1 | 976-976 | Treatment: suctioning - while resident |
O0100E1 | Asmt | Checklist | 1 | 977-977 | Treatment: tracheostomy care - while not resident |
O0100E2 | Asmt | Checklist | 1 | 978-978 | Treatment: tracheostomy care - while resident |
O0100F1 | Asmt | Checklist | 1 | 979-979 | Treatment: vent/respirator - while not resident |
O0100F2 | Asmt | Checklist | 1 | 980-980 | Treatment: vent/respirator - while resident |
O0100G1 | Asmt | Checklist | 1 | 981-981 | Treatment: BiPAP/CPAP - while not resident |
O0100G2 | Asmt | Checklist | 1 | 982-982 | Treatment: BIPAP/CPAP - while resident |
O0100H1 | Asmt | Checklist | 1 | 983-983 | Treatment: IV medications - while not resident |
O0100H2 | Asmt | Checklist | 1 | 984-984 | Treatment: IV medications - while resident |
O0100I1 | Asmt | Checklist | 1 | 985-985 | Treatment: transfusions - while not resident |
O0100I2 | Asmt | Checklist | 1 | 986-986 | Treatment: transfusions - while resident |
O0100J1 | Asmt | Checklist | 1 | 987-987 | Treatment: dialysis - while not resident |
O0100J2 | Asmt | Checklist | 1 | 988-988 | Treatment: dialysis - while resident |
O0100K1 | Asmt | Checklist | 1 | 989-989 | Treatment: hospice care - while not resident |
O0100K2 | Asmt | Checklist | 1 | 990-990 | Treatment: hospice care - while resident |
O0100L2 | Asmt | Checklist | 1 | 991-991 | Treatment: respite care - while resident |
O0100M1 | Asmt | Checklist | 1 | 992-992 | Treatment: isolate/quarantine - while not resident |
O0100M2 | Asmt | Checklist | 1 | 993-993 | Treatment: isolate/quarantine - while resident |
O0100Z1 | Asmt | Checklist | 1 | 994-994 | Treatment: none of above - while not resident |
O0100Z2 | Asmt | Checklist | 1 | 995-995 | Treatment: none of above - while resident |
O0250A | Asmt | Code | 1 | 996-996 | Was influenza vaccine received |
O0250B | Asmt | Date | 8 | 997-1004 | Date influenza vaccine received. |
O0250C | Asmt | Code | 1 | 1005-1005 | If influenza vaccine not received, state reason |
O0300A | Asmt | Code | 1 | 1006-1006 | Is pneumococcal vaccination up to date |
O0300B | Asmt | Code | 1 | 1007-1007 | If pneumococcal vacc not received, state reason |
O0400A1 | Asmt | Number | 4 | 1008-1011 | Speech-language/audiology: individ minutes |
O0400A2 | Asmt | Number | 4 | 1012-1015 | Speech-language/audiology: concur minutes |
O0400A3 | Asmt | Number | 4 | 1016-1019 | Speech-language/audiology: group minutes |
O0400A3A | Asmt | Number | 4 | 1472-1475 | Speech-language/audiology: co-treatment minutes |
O0400A4 | Asmt | Number | 1 | 1020-1020 | Speech-language/audiology: number of days |
O0400A5 | Asmt | Date | 8 | 1021-1028 | Speech-language/audiology: start date |
O0400A6 | Asmt | Date | 8 | 1029-1036 | Speech-language/audiology: end date |
O0400B1 | Asmt | Number | 4 | 1037-1040 | Occupational therapy: individ minutes |
O0400B2 | Asmt | Number | 4 | 1041-1044 | Occupational therapy: concur minutes |
O0400B3 | Asmt | Number | 4 | 1045-1048 | Occupational therapy: group minutes |
O0400B3A | Asmt | Number | 4 | 1476-1479 | Occupational therapy: co-treatment minutes |
O0400B4 | Asmt | Number | 1 | 1049-1049 | Occupational therapy: number of days |
O0400B5 | Asmt | Date | 8 | 1050-1057 | Occupational therapy: start date |
O0400B6 | Asmt | Date | 8 | 1058-1065 | Occupational therapy: end date |
O0400C1 | Asmt | Number | 4 | 1066-1069 | Physical therapy: individ minutes |
O0400C2 | Asmt | Number | 4 | 1070-1073 | Physical therapy: concur minutes |
O0400C3 | Asmt | Number | 4 | 1074-1077 | Physical therapy: group minutes |
O0400C3A | Asmt | Number | 4 | 1480-1483 | Physical therapy: co-treatment minutes |
O0400C4 | Asmt | Number | 1 | 1078-1078 | Physical therapy: number of days |
O0400C5 | Asmt | Date | 8 | 1079-1086 | Physical therapy: start date |
O0400C6 | Asmt | Date | 8 | 1087-1094 | Physical therapy: end date |
O0400D1 | Asmt | Number | 4 | 1095-1098 | Respiratory therapy: number of minutes |
O0400D2 | Asmt | Number | 1 | 1099-1099 | Respiratory therapy: number of days |
O0400E1 | Asmt | Number | 4 | 1100-1103 | Psychological therapy: number of minutes |
O0400E2 | Asmt | Number | 1 | 1104-1104 | Psychological therapy: number of days |
O0400F1 | Asmt | Number | 4 | 1105-1108 | Recreational therapy: number of minutes |
O0400F2 | Asmt | Number | 1 | 1109-1109 | Recreational therapy: number of days |
O0420 | Asmt | Number | 1 | 1484-1484 | Distinct calendar days of therapy |
O0450A | Asmt | Code | 1 | 1429-1429 | Has therapy resumed |
O0450B | Asmt | Date | 8 | 1430-1437 | Therapy resumption date |
O0500A | Asmt | Number | 1 | 1110-1110 | Range of motion (passive): number of days |
O0500B | Asmt | Number | 1 | 1111-1111 | Range of motion (active): number of days |
O0500C | Asmt | Number | 1 | 1112-1112 | Splint or brace assistance: number of days |
O0500D | Asmt | Number | 1 | 1113-1113 | Bed mobility training: number of days |
O0500E | Asmt | Number | 1 | 1114-1114 | Transfer training: number of days |
O0500F | Asmt | Number | 1 | 1115-1115 | Walking training: number of days |
O0500G | Asmt | Number | 1 | 1116-1116 | Dressing and/or grooming training: number of days |
O0500H | Asmt | Number | 1 | 1117-1117 | Eating and/or swallowing training: number of days |
O0500I | Asmt | Number | 1 | 1118-1118 | Amputation/prosthesis training: number of days |
O0500J | Asmt | Number | 1 | 1119-1119 | Communication training: number of days |
O0600 | Asmt | Number | 2 | 1120-1121 | Physician examinations: number of days |
O0700 | Asmt | Number | 2 | 1122-1123 | Physician orders: number of days |
P0100A | Asmt | Code | 1 | 1124-1124 | Restraints used in bed: bed rail |
P0100B | Asmt | Code | 1 | 1125-1125 | Restraints used in bed: trunk restraint |
P0100C | Asmt | Code | 1 | 1126-1126 | Restraints used in bed: limb restraint |
P0100D | Asmt | Code | 1 | 1127-1127 | Restraints used in bed: other |
P0100E | Asmt | Code | 1 | 1128-1128 | Restraints in chair/out of bed: trunk restraint |
P0100F | Asmt | Code | 1 | 1129-1129 | Restraints in chair/out of bed: limb restraint |
P0100G | Asmt | Code | 1 | 1130-1130 | Restraints in chair/out of bed: chair stops rising |
P0100H | Asmt | Code | 1 | 1131-1131 | Restraints in chair/out of bed: other |
Q0100A | Asmt | Code | 1 | 1132-1132 | Resident participated in assessment |
Q0100B | Asmt | Code | 1 | 1133-1133 | Family/signif other participated in assessment |
Q0100C | Asmt | Code | 1 | 1134-1134 | Guardian/legal rep participated in assessment |
Q0300A | Asmt | Code | 1 | 1135-1135 | Resident"s overall goal |
Q0300B | Asmt | Code | 1 | 1136-1136 | Information source for resident"s goal |
Q0400A | Asmt | Code | 1 | 1137-1137 | Active discharge planning for return to community |
Q0490 | Asmt | Code | 1 | 1463-1463 | Resident"s preference to avoid being asked |
Q0500B | Asmt | Code | 1 | 1140-1140 | Do you want to talk about returning to community |
Q0550A | Asmt | Code | 1 | 1464-1464 | Reasking resident preference |
Q0550B | Asmt | Code | 1 | 1465-1465 | Reasking resident preference source |
Q0600 | Asmt | Code | 1 | 1141-1141 | Referral been made to Local Contact Agency |
V0100A | Asmt | Code | 2 | 1142-1143 | Prior OBRA reason for assessment |
V0100B | Asmt | Code | 2 | 1144-1145 | Prior PPS reason for assessment |
V0100C | Asmt | Date | 8 | 1146-1153 | Prior assessment reference date |
V0100D | Asmt | Number | 2 | 1154-1155 | Prior assessment BIMS summary score |
V0100E | Asmt | Number | 2 | 1156-1157 | Prior asmt PHQ res: total mood severity score |
V0100F | Asmt | Number | 2 | 1158-1159 | Prior asmt PHQ staff: total mood score |
V0200A01A | Asmt | Checklist | 1 | 1160-1160 | CAA-Delirium: triggered |
V0200A01B | Asmt | Checklist | 1 | 1161-1161 | CAA-Delirium: plan |
V0200A02A | Asmt | Checklist | 1 | 1162-1162 | CAA-Cognitive loss/dementia: triggered |
V0200A02B | Asmt | Checklist | 1 | 1163-1163 | CAA-Cognitive loss/dementia: plan |
V0200A03A | Asmt | Checklist | 1 | 1164-1164 | CAA-Visual function: triggered |
V0200A03B | Asmt | Checklist | 1 | 1165-1165 | CAA-Visual function: plan |
V0200A04A | Asmt | Checklist | 1 | 1166-1166 | CAA-Communication: triggered |
V0200A04B | Asmt | Checklist | 1 | 1167-1167 | CAA-Communication: plan |
V0200A05A | Asmt | Checklist | 1 | 1168-1168 | CAA-ADL functional/rehab potential: triggered |
V0200A05B | Asmt | Checklist | 1 | 1169-1169 | CAA-ADL functional/rehab potential: plan |
V0200A06A | Asmt | Checklist | 1 | 1170-1170 | CAA-Urinary incont/indwell catheter: triggered |
V0200A06B | Asmt | Checklist | 1 | 1171-1171 | CAA-Urinary incont/indwell catheter: plan |
V0200A07A | Asmt | Checklist | 1 | 1172-1172 | CAA-Psychosocial well-being: triggered |
V0200A07B | Asmt | Checklist | 1 | 1173-1173 | CAA-Psychosocial well-being: plan |
V0200A08A | Asmt | Checklist | 1 | 1174-1174 | CAA-Mood state: triggered |
V0200A08B | Asmt | Checklist | 1 | 1175-1175 | CAA-Mood state: plan |
V0200A09A | Asmt | Checklist | 1 | 1176-1176 | CAA-Behavioral symptoms: triggered |
V0200A09B | Asmt | Checklist | 1 | 1177-1177 | CAA-Behavioral symptoms: plan |
V0200A10A | Asmt | Checklist | 1 | 1178-1178 | CAA-Activities: triggered |
V0200A10B | Asmt | Checklist | 1 | 1179-1179 | CAA-Activities: plan |
V0200A11A | Asmt | Checklist | 1 | 1180-1180 | CAA-Falls: triggered |
V0200A11B | Asmt | Checklist | 1 | 1181-1181 | CAA-Falls: plan |
V0200A12A | Asmt | Checklist | 1 | 1182-1182 | CAA-Nutritional status: triggered |
V0200A12B | Asmt | Checklist | 1 | 1183-1183 | CAA-Nutritional status: plan |
V0200A13A | Asmt | Checklist | 1 | 1184-1184 | CAA-Feeding tubes: triggered |
V0200A13B | Asmt | Checklist | 1 | 1185-1185 | CAA-Feeding tubes: plan |
V0200A14A | Asmt | Checklist | 1 | 1186-1186 | CAA-Dehydration/fluid maintenance: triggered |
V0200A14B | Asmt | Checklist | 1 | 1187-1187 | CAA-Dehydration/fluid maintenance: plan |
V0200A15A | Asmt | Checklist | 1 | 1188-1188 | CAA-Dental care: triggered |
V0200A15B | Asmt | Checklist | 1 | 1189-1189 | CAA-Dental care: plan |
V0200A16A | Asmt | Checklist | 1 | 1190-1190 | CAA-Pressure ulcer: triggered |
V0200A16B | Asmt | Checklist | 1 | 1191-1191 | CAA-Pressure ulcer: plan |
V0200A17A | Asmt | Checklist | 1 | 1192-1192 | CAA-Psychotropic drug use: triggered |
V0200A17B | Asmt | Checklist | 1 | 1193-1193 | CAA-Psychotropic drug use: plan |
V0200A18A | Asmt | Checklist | 1 | 1194-1194 | CAA-Physical restraints: triggered |
V0200A18B | Asmt | Checklist | 1 | 1195-1195 | CAA-Physical restraints: plan |
V0200A19A | Asmt | Checklist | 1 | 1196-1196 | CAA-Pain: triggered |
V0200A19B | Asmt | Checklist | 1 | 1197-1197 | CAA-Pain: plan |
V0200A20A | Asmt | Checklist | 1 | 1198-1198 | CAA-Return to community referral: triggered |
V0200A20B | Asmt | Checklist | 1 | 1199-1199 | CAA-Return to community referral: plan |
V0200B2 | Asmt | Date | 8 | 1200-1207 | CAA-Assessment process signature date |
V0200C2 | Asmt | Date | 8 | 1208-1215 | CAA-Care planning signature date |
X0150 | Asmt | Code | 1 | 1217-1217 | Correction: type of provider |
X0200A | Asmt | Text | 12 | 1218-1229 | Correction: resident first name |
X0200C | Asmt | Text | 18 | 1230-1247 | Correction: resident last name |
X0300 | Asmt | Code | 1 | 1248-1248 | Correction: resident gender |
X0400 | Asmt | Date | 8 | 1249-1256 | Correction: resident birth date |
X0500 | Asmt | Text | 9 | 1257-1265 | Correction: resident social security number |
X0600A | Asmt | Code | 2 | 1266-1267 | Correction: OBRA reason for assessment |
X0600B | Asmt | Code | 2 | 1268-1269 | Correction: PPS reason for assessment |
X0600C | Asmt | Code | 1 | 1270-1270 | Correction: OMRA assessment |
X0600D | Asmt | Code | 1 | 1271-1271 | Correction: Swing bed clinical change asmt |
X0600F | Asmt | Code | 2 | 1427-1428 | Correction: entry/discharge reporting |
X0600H | Asmt | Code | 1 | 1578-1578 | Correction: SNF PPS Part A Discharge (End of Stay) |
X0700A | Asmt | Date | 8 | 1273-1280 | Correction: assessment reference date |
X0700B | Asmt | Date | 8 | 1281-1288 | Correction: discharge date |
X0700C | Asmt | Date | 8 | 1289-1296 | Correction: entry date |
X0800 | Asmt | Number | 2 | 1297-1298 | Correction: correction number |
X0900A | Asmt | Checklist | 1 | 1299-1299 | Correction: modif reasons - transcription error |
X0900B | Asmt | Checklist | 1 | 1300-1300 | Correction: modif reasons - data entry error |
X0900C | Asmt | Checklist | 1 | 1301-1301 | Correction: modif reasons - software error |
X0900D | Asmt | Checklist | 1 | 1302-1302 | Correction: modif reasons - item coding error |
X0900E | Asmt | Checklist | 1 | 1438-1438 | Correction: modif reasons - resume therapy date |
X0900Z | Asmt | Checklist | 1 | 1303-1303 | Correction: modif reasons - other error |
X1050A | Asmt | Checklist | 1 | 1304-1304 | Correction: inact reasons - event did not occur |
X1050Z | Asmt | Checklist | 1 | 1305-1305 | Correction: inact reasons - other reason |
X1100A | Asmt | Text | 12 | 1306-1317 | Correction: attestor first name |
X1100B | Asmt | Text | 18 | 1318-1335 | Correction: attestor last name |
X1100E | Asmt | Date | 8 | 1336-1343 | Correction: attestation date |
Z0100A | Asmt | Text | 7 | 1344-1350 | Medicare Part A: HIPPS code |
Z0100B | Asmt | Text | 10 | 1351-1360 | Medicare Part A: RUG version code |
Z0100C | Asmt | Code | 1 | 1361-1361 | Medicare Part A: Medicare short stay asmt |
Z0150A | Asmt | Text | 7 | 1362-1368 | Medicare Part A: non-therapy HIPPS code |
Z0150B | Asmt | Text | 10 | 1369-1378 | Medicare Part A: non-therapy RUG version code |
Z0200A | Asmt | Text | 10 | 1379-1388 | State case mix: RUG group |
Z0200B | Asmt | Text | 10 | 1389-1398 | State case mix: RUG version code |
Z0250A | Asmt | Text | 10 | 1399-1408 | State case mix: Alternate RUG group |
Z0250B | Asmt | Text | 10 | 1409-1418 | State case mix: Alternate RUG version code |
Z0500B | Asmt | Date | 8 | 1419-1426 | Date RN signed assessment as complete |
ITEM_FILLER_001 | Filler | Text | 1 | 349-349 | Item filler: replaces byte 15 of A0700 |
ITEM_FILLER_002 | Filler | Text | 1 | 1272-1272 | Item filler: replaces old X0600F |
ITEM_FILLER_003 | Filler | Text | 8 | 2943-2950 | Item filler: replaces old EFFECTIVE_DATE |
ITEM_FILLER_004 | Filler | Text | 1 | 878-878 | Item filler: replaces old K0500A |
ITEM_FILLER_005 | Filler | Text | 1 | 879-879 | Item filler: replaces old K0500B |
ITEM_FILLER_006 | Filler | Text | 1 | 880-880 | Item filler: replaces old K0500C |
ITEM_FILLER_007 | Filler | Text | 1 | 881-881 | Item filler: replaces old K0500D |
ITEM_FILLER_008 | Filler | Text | 1 | 882-882 | Item filler: replaces old K0500Z |
ITEM_FILLER_009 | Filler | Text | 1 | 961-961 | Item filler: replaces old N0400A |
ITEM_FILLER_010 | Filler | Text | 1 | 962-962 | Item filler: replaces old N0400B |
ITEM_FILLER_011 | Filler | Text | 1 | 963-963 | Item filler: replaces old N0400C |
ITEM_FILLER_012 | Filler | Text | 1 | 964-964 | Item filler: replaces old N0400D |
ITEM_FILLER_013 | Filler | Text | 1 | 965-965 | Item filler: replaces old N0400E |
ITEM_FILLER_014 | Filler | Text | 1 | 966-966 | Item filler: replaces old N0400F |
ITEM_FILLER_015 | Filler | Text | 1 | 967-967 | Item filler: replaces old N0400G |
ITEM_FILLER_016 | Filler | Text | 1 | 968-968 | Item filler: replaces old N0400Z |
ITEM_FILLER_017 | Filler | Text | 1 | 1138-1138 | Item filler: replaces old Q0400B |
ITEM_FILLER_018 | Filler | Text | 1 | 1139-1139 | Item filler: replaces old Q0500A |
ITEM_FILLER_019 | Filler | Text | 1 | 883-883 | Item filler: replaces old K0700A |
ITEM_FILLER_020 | Filler | Text | 1 | 884-884 | Item filler: replaces old K0700B |
ITEM_FILLER_021 | Filler | Text | 1 | 2082-2082 | Item filler: replaces old S1200Z |
ITEM_FILLER_022 | Filler | Text | 1 | 2404-2404 | Item filler: replaces S8510A in fixed-format |
ITEM_FILLER_023 | Filler | Text | 1 | 2405-2405 | Item filler: replaces S8510B in fixed-format |
ITEM_FILLER_024 | Filler | Text | 1 | 2406-2406 | Item filler: replaces S8512A in fixed-format |
ITEM_FILLER_025 | Filler | Text | 1 | 2407-2407 | Item filler: replaces S8512B in fixed-format |
ITEM_FILLER_026 | Filler | Text | 1 | 538-538 | Item filler: replaces old C1300A |
ITEM_FILLER_027 | Filler | Text | 1 | 539-539 | Item filler: replaces old C1300B |
ITEM_FILLER_028 | Filler | Text | 1 | 540-540 | Item filler: replaces old C1300C |
ITEM_FILLER_029 | Filler | Text | 1 | 541-541 | Item filler: replaces old C1300D |
ITEM_FILLER_030 | Filler | Text | 1 | 542-542 | Item filler: replaces old C1600 |
ASMT_ITEMS_FILLER | Filler | Text | 348 | 1579-1926 | Assessment items filler |
S0101 | Asmt | Code | 1 | 1927-1927 | Admitted from Community |
S0102 | Asmt | Code | 1 | 1928-1928 | Admitted from NH or SB |
S0111 | Asmt | Code | 1 | 1929-1929 | Lived Alone |
S0115 | Asmt | Code | 1 | 1930-1930 | Spouse Location |
S0120 | Asmt | Text | 5 | 1931-1935 | Prior Residence ZIP Code |
S0122 | Asmt | Code | 2 | 1936-1937 | Prior Residence State |
S0123 | Asmt | Text | 3 | 1938-1940 | Prior Residence County |
S0125 | Asmt | Text | 5 | 1941-1945 | Prior Residence Town Code |
S0130 | Asmt | Code | 1 | 1946-1946 | Highest Education Completed |
S0140 | Asmt | Text | 11 | 1947-1957 | Physician License Number |
S0141 | Asmt | Text | 18 | 1958-1975 | Physician Name |
S0150 | Asmt | Text | 9 | 1976-1984 | State Resident ID |
S0160 | Asmt | Code | 2 | 2509-2510 | Specialty unit |
S0161A | Asmt | Checklist | 1 | 2536-2536 | Requires specialized unit: dementia/Alzheimer |
S0161B | Asmt | Checklist | 1 | 2537-2537 | Requires specialized unit: behavioral health |
S0161C | Asmt | Checklist | 1 | 2538-2538 | Requires specialized unit: TBI |
S0161D | Asmt | Checklist | 1 | 2539-2539 | Requires specialized unit: ventilator |
S0161Z | Asmt | Checklist | 1 | 2540-2540 | Requires specialized unit: none of the above |
S0165A | Asmt | Checklist | 1 | 2565-2565 | Specialty services: Dementia/Alzheimers |
S0165B | Asmt | Checklist | 1 | 2566-2566 | Specialty services: Behavioral Health |
S0165C | Asmt | Checklist | 1 | 2567-2567 | Specialty services: Traumatic Brain Injury |
S0165D | Asmt | Checklist | 1 | 2568-2568 | Specialty services: Ventilator |
S0165E | Asmt | Checklist | 1 | 2569-2569 | Specialty services: On-Site Dialysis |
S0165Z | Asmt | Checklist | 1 | 2570-2570 | Specialty services: None of the Above |
S0170A | Asmt | Code | 1 | 2511-2511 | Advanced directive: Guardian |
S0170B | Asmt | Code | 1 | 2512-2512 | Advanced directive: DPOA-HC |
S0170C | Asmt | Code | 1 | 2513-2513 | Advanced directive: Living will |
S0170D | Asmt | Code | 1 | 2514-2514 | Advanced directive: Do not resuscitate |
S0170E | Asmt | Code | 1 | 2515-2515 | Advanced directive: Do not hospitalize |
S0170F | Asmt | Code | 1 | 2516-2516 | Advanced directive: Do not intubate |
S0170G | Asmt | Code | 1 | 2517-2517 | Advanced directive: Feeding restrictions |
S0170H | Asmt | Code | 1 | 2518-2518 | Advanced directive: Other treatment restrictions |
S0170Z | Asmt | Code | 1 | 2519-2519 | Advanced directive: None of the above |
S0171A | Asmt | Code | 1 | 2520-2520 | Resident healthcare proxy exists |
S0171B | Asmt | Code | 1 | 2521-2521 | Resident healthcare proxy invoked |
S0172A | Asmt | Code | 1 | 2522-2522 | Goal discussion: documentation received |
S0172B | Asmt | Code | 1 | 2523-2523 | Goal discussion: hospital |
S0172C | Asmt | Code | 1 | 2524-2524 | Goal discussion: previous NH |
S0172D | Asmt | Code | 1 | 2525-2525 | Goal discussion: Home without home health services |
S0172E | Asmt | Code | 1 | 2526-2526 | Goal discussion: Home with home health services |
S0172F | Asmt | Code | 1 | 2527-2527 | Goal discussion: PCP office |
S0172G | Asmt | Code | 1 | 2528-2528 | Goal discussion: Other |
S0172H | Asmt | Code | 1 | 2529-2529 | Goal discussion: Not occur reason |
S0173 | Asmt | Code | 1 | 2535-2535 | Documentation of goals of care discussion |
S0174 | Asmt | Code | 1 | 2571-2571 | Resident has Advanced Directive |
S0175 | Asmt | Code | 1 | 2572-2572 | Resident has POA for Health Care |
S0180 | Asmt | Code | 1 | 1985-1985 | Discharged to Community |
S0183 | Asmt | Code | 1 | 2530-2530 | Discharged prior to admission assessment |
S0500 | Asmt | Code | 2 | 1986-1987 | Level of Care |
S0501 | Asmt | Code | 1 | 1988-1988 | CCNH RHNS Level of Care |
S0509 | Asmt | Code | 1 | 2602-2602 | PASRR Level 1 completed prior to admission |
S0510 | Asmt | Code | 1 | 1989-1989 | PASRR Screening Complete |
S0511 | Asmt | Date | 8 | 1990-1997 | PASRR Level 1 Complete Date |
S0512 | Asmt | Code | 1 | 1998-1998 | PASRR Level 1 |
S0513 | Asmt | Code | 1 | 2573-2573 | PASRR Screening Outcome |
S0520 | Asmt | Code | 2 | 1999-2000 | Reason for Admission |
S0600A | Asmt | Checklist | 1 | 2541-2541 | Meets criteria: requires ventilator 10+ hours |
S0600B | Asmt | Checklist | 1 | 2542-2542 | Meets criteria: requires ventilator 16+ hours |
S0600C | Asmt | Checklist | 1 | 2543-2543 | Meets criteria: Traumatic Brain Injury-Tier I |
S0600D | Asmt | Checklist | 1 | 2544-2544 | Meets criteria: Traumatic Brain Injury-Tier II |
S0600E | Asmt | Checklist | 1 | 2545-2545 | Meets criteria: Traumatic Brain Injury-Tier III |
S0600Z | Asmt | Checklist | 1 | 2546-2546 | Meets criteria: none of the above |
S1000 | Asmt | Code | 1 | 2001-2001 | Local Health Department Reporting |
S1001 | Asmt | Code | 1 | 2002-2002 | State Health Department Reporting |
S1002 | Asmt | Code | 1 | 2603-2603 | Local Health Department Reporting |
S1003 | Asmt | Code | 1 | 2604-2604 | State Health Department Reporting |
S1004 | Asmt | Code | 1 | 2605-2605 | Local/State Health Department Reporting |
S1100A | Asmt | Checklist | 1 | 2003-2003 | Disease: Clostridium Difficile |
S1100B | Asmt | Checklist | 1 | 2004-2004 | Disease: MRSA |
S1100C | Asmt | Checklist | 1 | 2005-2005 | Disease: VRE |
S1100D | Asmt | Checklist | 1 | 2006-2006 | Disease: VISA |
S1100E | Asmt | Checklist | 1 | 2007-2007 | Disease: VRSA |
S1100F | Asmt | Checklist | 1 | 2008-2008 | Disease: Other MDRO |
S1100F1 | Asmt | Text | 30 | 2009-2038 | Disease: MDRO Name1 |
S1100F2 | Asmt | Text | 30 | 2039-2068 | Disease: MDRO Name2 |
S1100G | Asmt | Checklist | 1 | 2069-2069 | Disease: Tuberculosis |
S1100H | Asmt | Checklist | 1 | 2070-2070 | Disease: Herpes Zoster |
S1100I | Asmt | Checklist | 1 | 2071-2071 | Disease: Scabies |
S1100J | Asmt | Checklist | 1 | 2574-2574 | Disease: CRE |
S1100Z | Asmt | Checklist | 1 | 2072-2072 | Disease: None of the Above |
S1150 | Asmt | Code | 1 | 2606-2606 | Active TBI Diagnosis |
S1200A | Asmt | Code | 1 | 2073-2073 | Primary/secondary SMI dx: schizophrenia |
S1200B | Asmt | Code | 1 | 2074-2074 | Primary/secondary SMI dx: delusional disorder |
S1200C | Asmt | Code | 1 | 2075-2075 | Primary/secondary SMI dx: schizoaffective disorder |
S1200D | Asmt | Code | 1 | 2076-2076 | Primary/secondary SMI dx: psychotic disorder NOS |
S1200E | Asmt | Code | 1 | 2077-2077 | Primary/secondary SMI dx: bipolar disorder I |
S1200F | Asmt | Code | 1 | 2078-2078 | Primary/secondary SMI dx: bipolar disorder II |
S1200G | Asmt | Code | 1 | 2079-2079 | Primary/secondary SMI dx: cyclothymic disorder |
S1200H | Asmt | Code | 1 | 2080-2080 | Primary/secondary SMI dx: bipolar disorder NOS |
S1200I | Asmt | Code | 1 | 2081-2081 | Primary/secondary SMI dx: major depress recurrent |
S2000 | Asmt | Code | 1 | 2083-2083 | Capable of self-administration of medications |
S2001 | Asmt | Code | 1 | 2084-2084 | Wishes to self-medicate |
S2010 | Asmt | Code | 1 | 2085-2085 | Refused meds 3 days |
S2011 | Asmt | Code | 1 | 2086-2086 | Staff support for meds 3 days |
S2015 | Asmt | Code | 1 | 2087-2087 | Refused meds occasionally 30 days |
S2016 | Asmt | Code | 1 | 2088-2088 | Refused meds frequently 30 days |
S2040 | Asmt | Code | 1 | 2089-2089 | Behavior Management Program |
S2050 | Asmt | Code | 1 | 2090-2090 | Resists grooming/hygiene |
S2060A | Asmt | Code | 1 | 2547-2547 | Resident centered care: Oasis |
S2060B | Asmt | Code | 1 | 2548-2548 | Resident centered care: habilitation therapy |
S2060C | Asmt | Code | 1 | 2549-2549 | Resident centered care: hand in hand |
S2060D | Asmt | Code | 1 | 2550-2550 | Resident centered care: consistent assignment |
S2060E | Asmt | Code | 1 | 2551-2551 | Resident centered care: other |
S2060Z | Asmt | Code | 1 | 2552-2552 | Resident centered care: none of the above |
S3100A | Asmt | Code | 1 | 2091-2091 | Contractures: Hand |
S3100B | Asmt | Code | 1 | 2092-2092 | Contractures: Wrist |
S3100C | Asmt | Code | 1 | 2093-2093 | Contractures: Elbow |
S3100D | Asmt | Code | 1 | 2094-2094 | Contractures: Shoulder |
S3100E | Asmt | Code | 1 | 2095-2095 | Contractures: Neck |
S3100F | Asmt | Code | 1 | 2096-2096 | Contractures: Ankle |
S3100G | Asmt | Code | 1 | 2097-2097 | Contractures: Knee |
S3100H | Asmt | Code | 1 | 2098-2098 | Contractures: Hip |
S3100Z | Asmt | Code | 1 | 2099-2099 | Contractures: Other |
S3200A | Asmt | Code | 1 | 2100-2100 | Dominant Side |
S3200B | Asmt | Code | 1 | 2101-2101 | Use of dominant hand/arm |
S3300 | Asmt | Code | 1 | 2575-2575 | Weight-based Equipment Need |
S3305A | Asmt | Checklist | 1 | 2576-2576 | Lifting device for weight |
S3305B | Asmt | Checklist | 1 | 2577-2577 | Wheelchair or mobility device for weight |
S3305C | Asmt | Checklist | 1 | 2578-2578 | Bed for weight |
S3305D | Asmt | Checklist | 1 | 2579-2579 | Seating for weight |
S3305E | Asmt | Checklist | 1 | 2580-2580 | More than 2 staff for weight |
S3305Y | Asmt | Checklist | 1 | 2581-2581 | Other for weight |
S3310A | Asmt | Checklist | 1 | 2607-2607 | Therapy Services Billed - Medicare Part A |
S3310B | Asmt | Checklist | 1 | 2608-2608 | Therapy Services Billed - Medicare Part B |
S3310C | Asmt | Checklist | 1 | 2609-2609 | Therapy Services Billed - Managed Care Entity |
S3310D | Asmt | Checklist | 1 | 2610-2610 | Therapy Services Billed - Medicaid |
S3310Y | Asmt | Checklist | 1 | 2611-2611 | Therapy Services Billed - Other |
S3310Z | Asmt | Checklist | 1 | 2612-2612 | Therapy Services Billed - None Of The Above |
S3315A | Asmt | Checklist | 1 | 2613-2613 | COPD Treatment - Oxygen |
S3315B | Asmt | Checklist | 1 | 2614-2614 | COPD Treatment - Inhaler/Nebulizer |
S3315C | Asmt | Checklist | 1 | 2615-2615 | COPD Treatment - Acute Monitoring Of Respiratory |
S3315D | Asmt | Checklist | 1 | 2616-2616 | COPD Treatment - Medications |
S3315Y | Asmt | Checklist | 1 | 2617-2617 | COPD Treatment - Other |
S3315Z | Asmt | Checklist | 1 | 2618-2618 | COPD Treatment - None Of The Above |
S4000A | Asmt | Code | 1 | 2102-2102 | Harm: Self Injury/Self-injurious attempt |
S4000B | Asmt | Code | 1 | 2103-2103 | Harm: Attempt was to kill self |
S4000C | Asmt | Code | 1 | 2104-2104 | Harm: Considered injuring self |
S4000D | Asmt | Code | 1 | 2105-2105 | Harm: Self-injury caregiver concern |
S4010A | Asmt | Number | 1 | 2106-2106 | Hourly Interval Observation |
S4010B | Asmt | Number | 1 | 2107-2107 | 15- Min. Interval Observation |
S4010C | Asmt | Number | 1 | 2108-2108 | 5- Min. Interval Observation |
S4010D | Asmt | Number | 1 | 2109-2109 | Constant Observation for < 1 hr |
S4010E | Asmt | Number | 1 | 2110-2110 | Constant Observation for > 1 hr |
S4500 | Asmt | Code | 1 | 2111-2111 | Substance Abuse: Alcoholic Drinks |
S4510A | Asmt | Code | 1 | 2112-2112 | Substance Abuse: Inhalants |
S4510B | Asmt | Code | 1 | 2113-2113 | Substance Abuse: Hallucinogens |
S4510C | Asmt | Code | 1 | 2114-2114 | Substance Abuse: Cocaine and Crack |
S4510D | Asmt | Code | 1 | 2115-2115 | Substance Abuse: Stimulants |
S4510E | Asmt | Code | 1 | 2116-2116 | Substance Abuse: Opiates |
S4510F | Asmt | Code | 1 | 2117-2117 | Substance Abuse: Cannabis |
S5000 | Asmt | Number | 1 | 2118-2118 | Number of New Pressure Ulcers |
S5005 | Asmt | Code | 1 | 2119-2119 | New Pressure Ulcer setting |
S5010A1 | Asmt | Code | 2 | 2120-2121 | Pressure ulcer 1 location |
S5010A2 | Asmt | Code | 1 | 2122-2122 | Pressure ulcer 1 status |
S5010B1 | Asmt | Code | 2 | 2123-2124 | Pressure ulcer 2 location |
S5010B2 | Asmt | Code | 1 | 2125-2125 | Pressure ulcer 2 status |
S5010C1 | Asmt | Code | 2 | 2126-2127 | Pressure ulcer 3 location |
S5010C2 | Asmt | Code | 1 | 2128-2128 | Pressure ulcer 3 status |
S5010D1 | Asmt | Code | 2 | 2129-2130 | Pressure ulcer 4 location |
S5010D2 | Asmt | Code | 1 | 2131-2131 | Pressure ulcer 4 status |
S5010E1 | Asmt | Code | 2 | 2132-2133 | Pressure ulcer 5 location |
S5010E2 | Asmt | Code | 1 | 2134-2134 | Pressure ulcer 5 status |
S5010F1 | Asmt | Code | 2 | 2135-2136 | Pressure ulcer 6 location |
S5010F2 | Asmt | Code | 1 | 2137-2137 | Pressure ulcer 6 status |
S5010G1 | Asmt | Code | 2 | 2138-2139 | Pressure ulcer 7 location |
S5010G2 | Asmt | Code | 1 | 2140-2140 | Pressure ulcer 7 status |
S5010H1 | Asmt | Code | 2 | 2141-2142 | Pressure ulcer 8 location |
S5010H2 | Asmt | Code | 1 | 2143-2143 | Pressure ulcer 8 status |
S5010I1 | Asmt | Code | 2 | 2144-2145 | Pressure ulcer 9 location |
S5010I2 | Asmt | Code | 1 | 2146-2146 | Pressure ulcer 9 status |
S6000 | Asmt | Code | 1 | 2147-2147 | Parenteral/IV feeding in NH |
S6005 | Asmt | Code | 1 | 2148-2148 | IV meds in NH |
S6010 | Asmt | Code | 1 | 2149-2149 | Oxygen Therapy in NH |
S6020A | Asmt | Checklist | 1 | 2582-2582 | Vent/resp specialized RN expertise |
S6020B | Asmt | Checklist | 1 | 2583-2583 | Vent/resp specialized CNA training needed |
S6020C | Asmt | Checklist | 1 | 2584-2584 | Vent/resp specialized therapy (PT,OT,RT) expertise |
S6020D | Asmt | Checklist | 1 | 2585-2585 | Vent/resp specialized equipment |
S6020Y | Asmt | Checklist | 1 | 2586-2586 | Vent/resp Other |
S6020Z | Asmt | Checklist | 1 | 2587-2587 | Vent/resp None of the Above |
S6022A | Asmt | Number | 1 | 2588-2588 | Vent/resp days licensed nurse: hourly intervals |
S6022B | Asmt | Number | 1 | 2589-2589 | Vent/resp days licensed nurse: 15-minute intervals |
S6022C | Asmt | Number | 1 | 2590-2590 | Vent/resp days licensed nurse: 5-minute intervals |
S6023A | Asmt | Number | 1 | 2591-2591 | Vent/resp days CNA: hourly intervals |
S6023B | Asmt | Number | 1 | 2592-2592 | Vent/resp days CNA: 15-minute intervals |
S6023C | Asmt | Number | 1 | 2593-2593 | Vent/resp days CNA: 5-minute intervals |
S6024A | Asmt | Number | 1 | 2594-2594 | Vent/resp days RT: hourly intervals |
S6024B | Asmt | Number | 1 | 2595-2595 | Vent/resp days RT: 15-minute intervals |
S6024C | Asmt | Number | 1 | 2596-2596 | Vent/resp days RT: 5-minute intervals |
S6050 | Asmt | Code | 1 | 2150-2150 | Isolation precautions needed |
S6051A | Asmt | Checklist | 1 | 2151-2151 | Isolation Precaution: Airborne |
S6051B | Asmt | Checklist | 1 | 2152-2152 | Isolation Precaution: Contact |
S6051C | Asmt | Checklist | 1 | 2153-2153 | Isolation Precaution: Droplet |
S6051D | Asmt | Checklist | 1 | 2154-2154 | Isolation Precaution: Protective |
S6052 | Asmt | Code | 1 | 2619-2619 | Isolation Required |
S6053A | Asmt | Date | 8 | 2620-2627 | Met Isolation Requirements Start Date |
S6053B | Asmt | Date | 8 | 2628-2635 | Met Isolation Requirements End Date |
S6100A | Asmt | Checklist | 1 | 2155-2155 | Vaccination: Varicella |
S6100B | Asmt | Checklist | 1 | 2156-2156 | Vaccination: Tetanus, diphtheria (Td) |
S6100C | Asmt | Checklist | 1 | 2157-2157 | Vaccination: Tetanus, diphtheria, pertussis (Tdap) |
S6100D | Asmt | Checklist | 1 | 2158-2158 | Vaccination: Measles, Mumps, Rubella (MMR) |
S6100E | Asmt | Checklist | 1 | 2159-2159 | Vaccination: Other |
S6100F1 | Asmt | Text | 20 | 2160-2179 | Vaccination: Other Name 1 |
S6100F2 | Asmt | Text | 20 | 2180-2199 | Vaccination: Other Name 2 |
S6100F3 | Asmt | Text | 20 | 2200-2219 | Vaccination: Other Name 3 |
S6100Z | Asmt | Checklist | 1 | 2220-2220 | Vaccination: None of the above |
S6200 | Asmt | Number | 2 | 2221-2222 | Number of Hospital Stays |
S6201 | Asmt | Number | 2 | 2636-2637 | Number of Unreported Hospital Stays |
S6205 | Asmt | Number | 1 | 2597-2597 | Number of Observation Stays |
S6210 | Asmt | Number | 3 | 2223-2225 | Number of ER visits |
S6211 | Asmt | Number | 3 | 2638-2640 | Number of Unreported ER Visits |
S6220 | Asmt | Code | 1 | 2226-2226 | Alzheimer"s/Dementia Special Care Unit |
S6230 | Asmt | Code | 1 | 2553-2553 | Has resident received antipsychotic |
S6232 | Asmt | Code | 1 | 2554-2554 | Is resident currently receiving antipsychotic |
S6234 | Asmt | Code | 1 | 2555-2555 | Attempt to reduce amount of antipsychotic |
S6236 | Asmt | Code | 1 | 2556-2556 | Was reduction in antipsychotic maintained |
S7000 | Asmt | Code | 1 | 2598-2598 | Dental Care |
S8000A1 | Asmt | Checklist | 1 | 2227-2227 | Medicare - Primary Payor |
S8000A2 | Asmt | Checklist | 1 | 2228-2228 | Medicare - Secondary Payor |
S8000A3 | Asmt | Checklist | 1 | 2229-2229 | Medicare Payor |
S8000B1 | Asmt | Checklist | 1 | 2230-2230 | Medicare Part A - Primary Payor |
S8000B2 | Asmt | Checklist | 1 | 2231-2231 | Medicare Part A - Secondary Payor |
S8000B3 | Asmt | Checklist | 1 | 2232-2232 | Medicare Part A Payor |
S8000C1 | Asmt | Checklist | 1 | 2233-2233 | Medicare Part B - Primary Payor |
S8000C2 | Asmt | Checklist | 1 | 2234-2234 | Medicare Part B - Secondary Payor |
S8000C3 | Asmt | Checklist | 1 | 2235-2235 | Medicare Part B Payor |
S8000D1 | Asmt | Checklist | 1 | 2236-2236 | Medicare Part C - Primary Payor |
S8000D2 | Asmt | Checklist | 1 | 2237-2237 | Medicare Part C - Secondary Payor |
S8000D3 | Asmt | Checklist | 1 | 2238-2238 | Medicare Part C Payor |
S8000E1 | Asmt | Checklist | 1 | 2239-2239 | Medicare per diem - Primary Payor |
S8000E2 | Asmt | Checklist | 1 | 2240-2240 | Medicare per diem - Secondary Payor |
S8000E3 | Asmt | Checklist | 1 | 2241-2241 | Medicare per diem Payor |
S8000Z | Asmt | Checklist | 1 | 2242-2242 | Medicare not a payment source |
S8010A1 | Asmt | Checklist | 1 | 2243-2243 | In-state Medicaid - Primary Payor |
S8010A2 | Asmt | Checklist | 1 | 2244-2244 | In-state Medicaid - Secondary Payor |
S8010A3 | Asmt | Checklist | 1 | 2245-2245 | In-state Medicaid payor |
S8010B1 | Asmt | Checklist | 1 | 2246-2246 | Out-of-state Medicaid - Primary Payor |
S8010B2 | Asmt | Checklist | 1 | 2247-2247 | Out-of-state Medicaid - Secondary Payor |
S8010B3 | Asmt | Checklist | 1 | 2248-2248 | Out-of-state Medicaid Payor |
S8010C1 | Asmt | Checklist | 1 | 2249-2249 | Medicaid per diem - Primary Payor |
S8010C2 | Asmt | Checklist | 1 | 2250-2250 | Medicaid per diem - Secondary Payor |
S8010C3 | Asmt | Checklist | 1 | 2251-2251 | Medicaid per diem Payor |
S8010D1 | Asmt | Checklist | 1 | 2252-2252 | Medicaid managed care per diem - Primary Payor |
S8010D2 | Asmt | Checklist | 1 | 2253-2253 | Medicaid managed care per diem - Secondary Payor |
S8010D3 | Asmt | Checklist | 1 | 2254-2254 | Medicaid managed care per diem Payor |
S8010E1 | Asmt | Checklist | 1 | 2255-2255 | Medicaid per diem (not MC) - Primary Payor |
S8010E2 | Asmt | Checklist | 1 | 2256-2256 | Medicaid per diem (not MC) - Secondary Payor |
S8010E3 | Asmt | Checklist | 1 | 2257-2257 | Medicaid per diem (not MC) Payor |
S8010F | Asmt | Code | 1 | 2531-2531 | Medicaid per diem type |
S8010F1 | Asmt | Checklist | 1 | 2258-2258 | Medicaid Resident Liability - Primary Payor |
S8010F2 | Asmt | Checklist | 1 | 2259-2259 | Medicaid Resident Liability - Secondary Payor |
S8010F3 | Asmt | Checklist | 1 | 2260-2260 | Medicaid Resident Liability Payor |
S8010G | Asmt | Code | 1 | 2532-2532 | Medicaid state source |
S8010G1 | Asmt | Checklist | 1 | 2261-2261 | Medicare Co-Pay - Primary Payor |
S8010G2 | Asmt | Checklist | 1 | 2262-2262 | Medicare Co-pay - Secondary Payor |
S8010G3 | Asmt | Checklist | 1 | 2263-2263 | Medicare Co-pay Payor |
S8010H1 | Asmt | Checklist | 1 | 2264-2264 | Picture Date reporting |
S8010H2 | Asmt | Checklist | 1 | 2265-2265 | Medicaid Other - Secondary Payor |
S8010H3 | Asmt | Checklist | 1 | 2266-2266 | Medicaid Other Payor |
S8010I1 | Asmt | Checklist | 1 | 2267-2267 | Medicaid Pending - Primary Payor |
S8010I2 | Asmt | Checklist | 1 | 2268-2268 | Medicaid Pending - Secondary Payor |
S8010I3 | Asmt | Checklist | 1 | 2269-2269 | Medicaid Pending Payor |
S8010Z | Asmt | Checklist | 1 | 2270-2270 | Medicaid not a payment source |
S8020A1 | Asmt | Checklist | 1 | 2271-2271 | Private - Primary Payor |
S8020A2 | Asmt | Checklist | 1 | 2272-2272 | Private - Secondary Payor |
S8020A3 | Asmt | Checklist | 1 | 2273-2273 | Private Payor |
S8020B1 | Asmt | Checklist | 1 | 2274-2274 | Private per diem - Primary Payor |
S8020B2 | Asmt | Checklist | 1 | 2275-2275 | Private per diem - Secondary Payor |
S8020B3 | Asmt | Checklist | 1 | 2276-2276 | Private per diem Payor |
S8020C1 | Asmt | Checklist | 1 | 2277-2277 | Private LTC insurance policy - Primary Payor |
S8020C2 | Asmt | Checklist | 1 | 2278-2278 | Private LTC insurance policy - Secondary Payor |
S8020C3 | Asmt | Checklist | 1 | 2279-2279 | Private LTC insurance policy |
S8020Z | Asmt | Checklist | 1 | 2280-2280 | Private insurance not a payment source |
S8030A1 | Asmt | Checklist | 1 | 2281-2281 | Self-pay - Primary Payor |
S8030A2 | Asmt | Checklist | 1 | 2282-2282 | Self-pay - Secondary Payor |
S8030A3 | Asmt | Checklist | 1 | 2283-2283 | Self-pay Payor |
S8030B1 | Asmt | Checklist | 1 | 2284-2284 | Family pay - Primary Payor |
S8030B2 | Asmt | Checklist | 1 | 2285-2285 | Family pay - Secondary Payor |
S8030B3 | Asmt | Checklist | 1 | 2286-2286 | Family pay Payor |
S8030C | Asmt | Checklist | 1 | 2287-2287 | Self or Family pay for full per diem |
S8030Z | Asmt | Checklist | 1 | 2288-2288 | Self or Family not a payment source |
S8040A1 | Asmt | Checklist | 1 | 2289-2289 | State Run Medical Assistance - Primary Payor |
S8040A2 | Asmt | Checklist | 1 | 2290-2290 | State Run Medical Assistance - Secondary Payor |
S8040A3 | Asmt | Checklist | 1 | 2291-2291 | State Run Medical Assistance Payor |
S8040B1 | Asmt | Checklist | 1 | 2292-2292 | Tricare per diem - Primary Payor |
S8040B2 | Asmt | Checklist | 1 | 2293-2293 | Tricare per diem - Secondary Payor |
S8040B3 | Asmt | Checklist | 1 | 2294-2294 | Tricare per diem Payor |
S8040C1 | Asmt | Checklist | 1 | 2295-2295 | VA per diem - Primary Payor |
S8040C2 | Asmt | Checklist | 1 | 2296-2296 | VA per diem - Secondary Payor |
S8040C3 | Asmt | Checklist | 1 | 2297-2297 | VA per diem Payor |
S8040D1 | Asmt | Checklist | 1 | 2298-2298 | Other Public - Primary Payor |
S8040D2 | Asmt | Checklist | 1 | 2299-2299 | Other Public - Secondary Payor |
S8040D3 | Asmt | Checklist | 1 | 2300-2300 | Other Public Payor |
S8040Z | Asmt | Checklist | 1 | 2301-2301 | Other government not a payment source |
S8050A1 | Asmt | Checklist | 1 | 2302-2302 | Other - Primary Payor |
S8050A2 | Asmt | Checklist | 1 | 2303-2303 | Other - Secondary Payor |
S8050A3 | Asmt | Checklist | 1 | 2304-2304 | Other Payor |
S8050B | Asmt | Text | 30 | 2305-2334 | Other Payor Name 1 |
S8050C | Asmt | Text | 30 | 2335-2364 | Other Payor Name 2 |
S8050D | Asmt | Text | 30 | 2365-2394 | Other Payor Name 3 |
S8055 | Asmt | Code | 1 | 2533-2533 | Primary payor |
S8099 | Asmt | Checklist | 1 | 2395-2395 | Payor: None of the Above |
S8500 | Asmt | Date | 8 | 2396-2403 | Medicaid begin date |
S8510A | Asmt | Number | 2 | 2557-2558 | Medicaid Therapeutic bed-hold days since last asmt |
S8510B | Asmt | Number | 2 | 2559-2560 | Medicaid Therapeutic bed-hold days - YTD |
S8512A | Asmt | Number | 2 | 2561-2562 | Medicaid hospital bed-hold days since last asmt |
S8512B | Asmt | Number | 2 | 2563-2564 | Medicaid hospital bed-hold days - YTD |
S8520A | Asmt | Code | 1 | 2408-2408 | Medicaid Leave Days Type 1 |
S8520B | Asmt | Date | 8 | 2409-2416 | Leave Days for Medicaid begin date 1 |
S8520C | Asmt | Date | 8 | 2417-2424 | Leave Days for Medicaid end date 1 |
S8521A | Asmt | Code | 1 | 2425-2425 | Medicaid Leave Days Type 2 |
S8521B | Asmt | Date | 8 | 2426-2433 | Leave Days for Medicaid begin date 2 |
S8521C | Asmt | Date | 8 | 2434-2441 | Leave Days for Medicaid end date 2 |
S9000 | Asmt | Code | 1 | 2442-2442 | IL Skills Training |
S9001 | Asmt | Code | 1 | 2443-2443 | IL IDPH Subpart S criteria |
S9002A | Asmt | Checklist | 1 | 2444-2444 | IL IDPH Subpart S: Schizophrenia |
S9002B | Asmt | Checklist | 1 | 2445-2445 | IL IDPH Subpart S: Delusional disorder |
S9002C | Asmt | Checklist | 1 | 2446-2446 | IL IDPH Subpart S: Schizoaffective disorder |
S9002D | Asmt | Checklist | 1 | 2447-2447 | IL IDPH Subpart S:Psychotic disorder not specified |
S9002E | Asmt | Checklist | 1 | 2448-2448 | IL IDPH Subpart S: Bipolar I mixed, manic, & depr |
S9002F | Asmt | Checklist | 1 | 2449-2449 | IL IDPH Subpart S: Bipolar disorder II |
S9002G | Asmt | Checklist | 1 | 2450-2450 | IL IDPH Subpart S: Cyclothymic disorder |
S9002H | Asmt | Checklist | 1 | 2451-2451 | IL IDPH Subpart S: Bipolar disorder not specified |
S9002I | Asmt | Checklist | 1 | 2452-2452 | IL IDPH Subpart S: Major depression, recurrent |
S9003 | Asmt | Code | 1 | 2453-2453 | IL IDPH Subpart S: Ancillary |
S9020 | Asmt | Text | 8 | 2454-2461 | FL FRAES number |
S9040A | Asmt | Code | 1 | 2462-2462 | CA POLST |
S9040B | Asmt | Code | 1 | 2463-2463 | CA POLST Section A |
S9040C | Asmt | Code | 1 | 2464-2464 | CA POLST Section B |
S9040C1 | Asmt | Code | 1 | 2599-2599 | CA POLST Section B (revised) |
S9040D | Asmt | Code | 1 | 2465-2465 | CA POLST Section C |
S9040D1 | Asmt | Code | 1 | 2600-2600 | CA POLST Section C (revised) |
S9040E | Asmt | Code | 1 | 2466-2466 | CA POLST D physician signature |
S9040F | Asmt | Code | 1 | 2467-2467 | CA POLST D resident signature |
S9040G | Asmt | Code | 1 | 2468-2468 | CA POLST D discussed with patient or decisionmaker |
S9040H | Asmt | Code | 1 | 2534-2534 | CA POLST advanced directive |
S9060 | Asmt | Code | 1 | 2469-2469 | NY Medicaid add-on eligibility |
S9080A | Asmt | Code | 1 | 2470-2470 | PA MA CASE-MIX |
S9080B | Asmt | Date | 8 | 2471-2478 | PA MA CASE-MIX Date |
S9080C | Asmt | Text | 10 | 2479-2488 | PA MA CASE-MIX Access Card Number |
S9080D | Asmt | Date | 8 | 2489-2496 | PA MA CASE-MIX MA NF Effective Date |
S9080E | Asmt | Code | 1 | 2497-2497 | PA MA CASE-MIX Day One MA |
S9100A | Asmt | Code | 1 | 2498-2498 | VA Room & Board Payment Assessment Reference Date |
S9100B | Asmt | Code | 1 | 2499-2499 | VA Room & Board Payment Entry Date |
S9100C | Asmt | Date | 8 | 2500-2507 | VA Medicaid Room & Board initial date |
S9120 | Asmt | Code | 1 | 2508-2508 | CT Approved LTC |
S9140 | Asmt | Code | 1 | 2601-2601 | Completed LAPOST |
STATE_ITEMS_FILLER | Filler | Text | 286 | 2641-2926 | Section S (State items) filler |
ASSESSMENT_ID | Calc | Number | 15 | 2951-2965 | Assessment internal ID |
ORIGINAL_ASSESSMENT_ID | Calc | Number | 15 | 2966-2980 | Original assessment ID |
RESIDENT_INTERNAL_ID | Calc | Number | 10 | 2981-2990 | Resident internal ID |
TARGET_DATE | Calc | Date | 8 | 2927-2934 | Target date |
FACILITY_PROVIDER_INTERNAL_ID | Calc | Number | 10 | 3063-3072 | Facility/provider internal ID |
SUBMISSION_ID | Calc | Number | 15 | 3021-3035 | Submission ID |
SUBMISSION_DATE | Calc | Date | 8 | 3036-3043 | Submission date |
SUBMISSION_COMPLETE_DATE | Calc | Date | 8 | 3044-3051 | Submission processing completion date |
SUBMITTING_USER_ID | Calc | Text | 30 | 2991-3020 | Submitter user ID |
RESIDENT_MATCH_CRITERIA | Calc | Number | 2 | 3052-3053 | Resident matching criteria |
RESIDENT_AGE | Calc | Number | 8 | 2935-2942 | Age of resident on the target date |
BIRTHDATE_SUBMIT_CODE | Calc | Code | 1 | 3258-3258 | Birth date submit code |
CBSA_URBAN_RURAL_CODE | Calc | Code | 1 | 3054-3054 | CBSA urban/rural code. |
STATE_EXTRACT_FILE_ID | Calc | Number | 8 | 3055-3062 | State extract file identifier |
RECALCULATED_Z0100A | Calc | Text | 7 | 3073-3079 | Calculated Medicare Part A HIPPS code |
CMI_VALUE_FOR_RECALC_Z0100A | Calc | Text | 7 | 3091-3097 | Medicare CMI value returned for Part A |
CMI_SET_FOR_RECALC_Z0100A | Calc | Text | 3 | 3098-3100 | Medicare CMI Set Code used for Part A |
RECALCULATED_Z0100B | Calc | Text | 10 | 3080-3089 | Calculated Medicare Part A RUG version code |
RECALCULATED_Z0100C | Calc | Text | 1 | 3090-3090 | Calculated Medicare Part A HIPPS stay type code |
RECALCULATED_Z0150A | Calc | Text | 7 | 3101-3107 | Calculated Medicare Non-therapy Part A RUG code |
CMI_VALUE_FOR_RECALC_Z0150A | Calc | Text | 7 | 3118-3124 | Medicare CMI value returned for Part A Non-therapy |
CMI_SET_FOR_RECALC_Z0150A | Calc | Text | 3 | 3125-3127 | Medicare CMI Set Code used for Part A Non-therapy |
RECALCULATED_Z0150B | Calc | Text | 10 | 3108-3117 | Calculated Medicare Non-therapy Part A RUG version |
RECALCULATED_Z0200A | Calc | Text | 10 | 3128-3137 | Calculated Medicaid RUG code |
CMI_VALUE_FOR_Z0200A | Calc | Text | 7 | 3148-3154 | Medicaid CMI value returned for Medicaid RUG |
CMI_SET_FOR_RECALC_Z0200A | Calc | Text | 3 | 3155-3157 | Medicare Set Code used for Medicaid RUG |
RECALCULATED_Z0200B | Calc | Text | 10 | 3138-3147 | Calculated Medicaid RUG version code |
RECALCULATED_Z0250A | Calc | Text | 10 | 3158-3167 | Alternate Calculated Medicaid RUG code |
CMI_VALUE_FOR_RECALC_Z0250A | Calc | Text | 7 | 3178-3184 | Alternate Medicaid CMI value for Medicaid RUG |
CMI_SET_FOR_RECALC_Z0250A | Calc | Text | 3 | 3185-3187 | Alternate Medicaid Set Code used for Medicaid RUG |
RECALCULATED_Z0250B | Calc | Text | 10 | 3168-3177 | Alternate Calculated Medicaid RUG version code |
MEDICARE_RUG4_HIER_GRP | Calc | Text | 10 | 3188-3197 | RUG IV Medicare hierarchical group |
MEDICARE_RUG4_HIER_VERSION | Calc | Text | 10 | 3198-3207 | RUG IV Medicare hierarchical version |
MEDICARE_RUG3_IDX_MAX_GRP | Calc | Text | 10 | 3208-3217 | RUG III Medicare index max group |
MEDICARE_RUG3_IDX_MAX_VERSION | Calc | Text | 10 | 3218-3227 | RUG III Medicare index max version |
MEDICARE_RUG3_IDX_MAX_CMI_VAL | Calc | Text | 7 | 3228-3234 | RUG III Medicare index max case mix index |
MEDICARE_RUG3_IDX_MAX_CMI_SET | Calc | Text | 3 | 3235-3237 | RUG III Medicare index max case mix index set |
MEDICARE_RUG3_HIER_GRP | Calc | Text | 10 | 3238-3247 | RUG III Medicare hierarchical group |
MEDICARE_RUG3_HIER_VERSION | Calc | Text | 10 | 3248-3257 | RUG III Medicare hierarchical version |
C_CCN_NUM | Calc | Text | 12 | 3259-3270 | Calculated facility CMS certification number (CCN) |
CALCULATED_ITEMS_FILLER1 | Filler | Text | 417 | 3271-3687 | Calculated items filler |
DATA_END_INDICATOR | Calc | Code | 1 | 3688-3688 | End of data terminator code |
CR | Calc | Code | 1 | 3689-3689 | Carriage return (ASCII 013) |
LF | Calc | Code | 1 | 3690-3690 | Line feed character (ASCII 010) |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 08/31/2016 09:05:46 AM