-3009


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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