-3009
Property | Specification |
Data System | HOPE |
Data Specs | V1.00.1 |
Edit Type | Format |
Severity | Fatal |
Edit Text |
Values of Code and Checklist Items: Only the coded values listed in the "Item Values" table of the Detailed Data Specifications Report may be submitted for this item. |
Version Notes | [V1.00.1]-Removed mapping to item J2052B and mapped it to the date format edit -3010. Removed mapping to deleted item A0800 and added mapping to new item A0810. Added mapping to ASMT_SYS_CD. |
Item List | |
Item ID | Description |
ASMT_SYS_CD | Assessment system code |
ITM_SBST_CD | Item subset code |
STATE_CD | Provider"s state postal code |
A0050 | Type of record |
A0215 | Site of service at admission |
A0250 | Reason for record |
A0810 | Sex |
A1005A | Ethnicity: No, not Hispanic, Latino/a, Spanish |
A1005B | Ethnicity: Yes, Mex, Mex Amer, Chicano/a |
A1005C | Ethnicity: Yes, Puerto Rican |
A1005D | Ethnicity: Yes, Cuban |
A1005E | Ethnicity: Yes, another Hispanic/Latino/Spanish |
A1005X | Ethnicity: Patient unable to respond |
A1005Y | Ethnicity: Patient declines to respond |
A1010A | Race: White |
A1010B | Race: Black or African American |
A1010C | Race: American Indian or Alaska Native |
A1010D | Race: Asian Indian |
A1010E | Race: Chinese |
A1010F | Race: Filipino |
A1010G | Race: Japanese |
A1010H | Race: Korean |
A1010I | Race: Vietnamese |
A1010J | Race: Other Asian |
A1010K | Race: Native Hawaiian |
A1010L | Race: Guamanian or Chamorro |
A1010M | Race: Samoan |
A1010N | Race: Other Pacific Islander |
A1010X | Race: Patient unable to respond |
A1010Y | Race: Patient declines to respond |
A1010Z | Race: None of the above |
A1110B | Does the patient need or want an interpreter |
A1400A | Payer: Medicare (FFS) |
A1400B | Payer: Medicare (managed care/Part C/Mcr Advant.) |
A1400C | Payer: Medicaid (FFS) |
A1400D | Payer: Medicaid (managed care) |
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 |
A1805 | Admitted from |
A1905 | Living Arrangements |
A1910 | Availability of Assistance |
A2115 | Reason for discharge |
F2000A | Was ptnt/rsp prty asked about CPR |
F2100A | Was ptnt/rsp prty asked treatments oth than CPR |
F2200A | Was ptnt/rsp prty asked hospitalization |
F3000A | Was ptnt/crgvr asked sprtual/exstntial cncrns |
I0010 | Principal diagnosis |
I0100 | Cancer |
I0600 | Heart Failure |
I0900 | Peripheral Disease (PVD or PAD) |
I0950 | Cardiovascular (excluding heart failure) |
I1101 | Liver disease (e.g., cirrhosis) |
I6202 | Chronic Obstructive Pulmonary Disease (COPD) |
I2102 | Sepsis |
I2900 | Diabetes Mellitus (DM) |
I2910 | Neuropathy |
I4501 | Stroke |
I4801 | Dementia (including Alzheimer"s disease) |
I5150 | Neurological Conditions |
I5401 | Seizure Disorder |
I1510 | Renal disease |
I8005 | Other Medical Condition |
J0050 | Death is Imminent |
J0900A | Was patient screened for pain |
J0900C | Patient"s pain severity was |
J0900D | Type of standardized pain tool used |
J0905 | Is pain an active problem for the patient? |
J0910A | Was comprehensive pain assessment done |
J0910C1 | Pain asmt included: location |
J0910C2 | Pain asmt included: severity |
J0910C3 | Pain asmt included: character |
J0910C4 | Pain asmt included: duration |
J0910C5 | Pain asmt included: frequency |
J0910C6 | Pain asmt included: what relieves/worsens |
J0910C7 | Pain asmt included: effect function/quality life |
J0910C9 | Pain asmt included: none of the above |
J0915 | Neuropathic Pain |
J2030A | Was patient screened for shortness of breath |
J2030C | Did screening indicate pt had shortness of breath |
J2040A | Was treatment for shortness of breath initiated |
J2050A | Was symptom impact screening completed |
J2051A | Symptom Impact - Pain |
J2051B | Symptom Impact - Shortness of breath |
J2051C | Symptom Impact - Anxiety |
J2051D | Symptom Impact - Nausea |
J2051E | Symptom Impact - Vomiting |
J2051F | Symptom Impact - Diarrhea |
J2051G | Symptom Impact - Constipation |
J2051H | Symptom Impact - Agitation |
J2052A | Was in-person SFV completed |
J2052C | Reason SFV Not Completed |
J2053A | SFV Symptom Impact Since Screen - Pain |
J2053B | SFV Symptom Impact Since Screen - Shortness breath |
J2053C | SFV Symptom Impact Since Screen - Anxiety |
J2053D | SFV Symptom Impact Since Screen - Nausea |
J2053E | SFV Symptom Impact Since Screen - Vomiting |
J2053F | SFV Symptom Impact Since Screen - Diarrhea |
J2053G | SFV Symptom Impact Since Screen - Constipation |
J2053H | SFV Symptom Impact Since Screen - Agitation |
M1190 | Patient has one or more skin conditions |
M1195A | Skin Condition - Diabetic foot ulcer(s) |
M1195B | Skin Condition - Open lesion(s) |
M1195C | Skin Condition - Pressure Ulcer(s)/Injuries |
M1195D | Skin Condition - Rash(es) |
M1195E | Skin Condition - Skin tear(s) |
M1195F | Skin Condition - Surgical wound(s) |
M1195G | Skin Condition - Ulcers (not diabetic or pressure) |
M1195H | Skin Condition - Moisture Associated Skin Damage |
M1195Z | Skin Condition - None of the above |
M1200A | Treatments - Pressure reducing device for chair |
M1200B | Treatments - Pressure reducing device for bed |
M1200C | Treatments - Turning/repositioning program |
M1200D | Treatments - Nutrition or hydration intervention |
M1200E | Treatments - Pressure ulcer/injury care |
M1200F | Treatments - Surgical wound care |
M1200G | Treatments - Apply nonsurgical dressings-not feet |
M1200H | Treatments - Apply ointments/meds (not feet) |
M1200I | Treatments - Application of dressings to feet |
M1200J | Treatments - Incontinence Management |
M1200Z | Treatments - None of the above |
N0500A | Was scheduled opioid initiated or continued |
N0510A | Was PRN opioid initiated or continued |
N0520A | Was bowel regimen initiated or continued |
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Generated: 04/16/2025 02:54:58 PM