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Data Element Search by Assessment Instrument Version

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List of Data Element Search Results

Assessment
Instrument
Item ID Section Name Short Name

LCDS

A0050

Section A: Administrative Information

Type of transaction

LCDS

A0100

Section A: Administrative Information

{Facility/Provider} numbers

LCDS

A0100A

Section A: Administrative Information

National Provider Identifier (NPI)

LCDS

A0100B

Section A: Administrative Information

CMS Certification Number (CCN)

LCDS

A0100C

Section A: Administrative Information

State Medicaid {facility/provider} number

LCDS

A0200

Section A: Administrative Information

Type of {facility/provider}

LCDS

A0210

Section A: Administrative Information

Assessment reference date

LCDS

A0220

Section A: Administrative Information

Admission date

LCDS

A0250

Section A: Administrative Information

Reason for assessment (record)

LCDS

A0270

Section A: Administrative Information

Discharge date

LCDS

A0500

Section A: Administrative Information

Legal name of {patient/resident}

LCDS

A0500A

Section A: Administrative Information

{Patient/Resident} first name

LCDS

A0500B

Section A: Administrative Information

{Patient/Resident} middle initial

LCDS

A0500C

Section A: Administrative Information

{Patient/Resident} last name

LCDS

A0500D

Section A: Administrative Information

{Patient/Resident} name suffix

LCDS

A0600

Section A: Administrative Information

Social security and Medicare numbers

LCDS

A0600A

Section A: Administrative Information

Social security number

LCDS

A0600B

Section A: Administrative Information

Medicare number

LCDS

A0700

Section A: Administrative Information

Medicaid number

LCDS

A0800

Section A: Administrative Information

Gender

LCDS

A0900

Section A: Administrative Information

Birth date

LCDS

A1005

Section A: Administrative Information

Ethnicity. Check all that apply

LCDS

A1010

Section A: Administrative Information

Race. Check all that apply

LCDS

A1110

Section A: Administrative Information

Language

LCDS

A1110A

Section A: Administrative Information

Preferred language

LCDS

A1110B

Section A: Administrative Information

Interpreter

LCDS

A1200

Section A: Administrative Information

Marital status

LCDS

A1250

Section A: Administrative Information

Transportation (from NACHC). Check all that apply

LCDS

A1400

Section A: Administrative Information

Payer information. Check all that apply

LCDS

A1805

Section A: Administrative Information

Admitted from

LCDS

A1990

Section A: Administrative Information

Discharge against medical advice

LCDS

A2105

Section A: Administrative Information

Discharge location

LCDS

A2121

Section A: Administrative Information

Provision of current reconciled medication list to subsequent provider

LCDS

A2122

Section A: Administrative Information

Route of current reconciled medication list to subsequent provider. Check all that apply

LCDS

A2123

Section A: Administrative Information

Provision of current reconciled medication list to {patient/resident}

LCDS

A2124

Section A: Administrative Information

Route of current reconciled medication list transmission to {patient/resident}. Check all that apply

LCDS

B0100

Section B: Hearing, Speech, and Vision

Comatose

LCDS

B0200

Section B: Hearing, Speech, and Vision

Hearing

LCDS

B1000

Section B: Hearing, Speech, and Vision

Vision

LCDS

B1300

Section B: Hearing, Speech, and Vision

Health literacy

LCDS

BB0700

Section B: Hearing, Speech, and Vision

Expression of ideas and wants

LCDS

BB0800

Section B: Hearing, Speech, and Vision

Understanding verbal and non-verbal content

LCDS

C0100

Section C: Cognitive Patterns

BIMS: should {patient/resident} interview be conducted

LCDS

C0200

Section C: Cognitive Patterns

BIMS: repetition of three words

LCDS

C0300

Section C: Cognitive Patterns

Temporal orientation (orientation to year, month, and day)

LCDS

C0300A

Section C: Cognitive Patterns

BIMS: able to report correct year

LCDS

C0300B

Section C: Cognitive Patterns

BIMS: able to report correct month

LCDS

C0300C

Section C: Cognitive Patterns

BIMS: able report correct day of week

LCDS

C0400

Section C: Cognitive Patterns

BIMS: Recall

LCDS

C0400A

Section C: Cognitive Patterns

BIMS: able to recall "sock"

LCDS

C0400B

Section C: Cognitive Patterns

BIMS: able to recall "blue"

LCDS

C0400C

Section C: Cognitive Patterns

BIMS: able to recall "bed"

LCDS

C0500

Section C: Cognitive Patterns

BIMS: summary score

LCDS

C1310

Section C: Cognitive Patterns

Signs and symptoms of delirium (from CAM)

LCDS

C1310A

Section C: Cognitive Patterns

CAM: Acute onset mental status change

LCDS

C1310B

Section C: Cognitive Patterns

CAM: Inattention

LCDS

C1310C

Section C: Cognitive Patterns

CAM: Disorganized Thinking

LCDS

C1310D

Section C: Cognitive Patterns

CAM: Altered Level of Consciousness

LCDS

D0150

Section D: Mood

Patient mood interview (PHQ-2 to 9) (from Pfizer Inc.)

LCDS

D0150A1

Section D: Mood

PHQ-2 to 9: little interest or pleasure - presence

LCDS

D0150A2

Section D: Mood

PHQ-2 to 9: little interest or pleasure - frequency

LCDS

D0150B1

Section D: Mood

PHQ-2 to 9: feeling down, depressed - presence

LCDS

D0150B2

Section D: Mood

PHQ-2 to 9: feeling down, depressed - frequency

LCDS

D0150C1

Section D: Mood

PHQ-2 to 9: trouble with sleep - presence

LCDS

D0150C2

Section D: Mood

PHQ-2 to 9: trouble with sleep - frequency

LCDS

D0150D1

Section D: Mood

PHQ-2 to 9: feeling tired/little energy - presence

LCDS

D0150D2

Section D: Mood

PHQ-2 to 9: feeling tired/little energy - frequency

LCDS

D0150E1

Section D: Mood

PHQ-2 to 9: poor appetite or overeating - presence

LCDS

D0150E2

Section D: Mood

PHQ-2 to 9: poor appetite or overeating - frequency

LCDS

D0150F1

Section D: Mood

PHQ-2 to 9: feeling bad about yourself - presence

LCDS

D0150F2

Section D: Mood

PHQ-2 to 9: feeling bad about yourself - frequency

LCDS

D0150G1

Section D: Mood

PHQ-2 to 9: trouble concentrating - presence

LCDS

D0150G2

Section D: Mood

PHQ-2 to 9: trouble concentrating - frequency

LCDS

D0150H1

Section D: Mood

PHQ-2 to 9: slow, fidgety, restless - presence

LCDS

D0150H2

Section D: Mood

PHQ-2 to 9: slow, fidgety, restless - frequency

LCDS

D0150I1

Section D: Mood

PHQ-2 to 9: thoughts better off dead - presence

LCDS

D0150I2

Section D: Mood

PHQ-2 to 9: thoughts better off dead - frequency

LCDS

D0160

Section D: Mood

PHQ-2 to 9: total severity score

LCDS

D0700

Section D: Mood

Social Isolation (from Creative Commons)

LCDS

GG0100

Section GG: Functional Abilities and Goals

Prior functioning: everyday activities

LCDS

GG0100B

Section GG: Functional Abilities and Goals

Indoor mobility (ambulation)

LCDS

GG0110

Section GG: Functional Abilities and Goals

Prior device use. Check all that apply

LCDS

GG0130

Section GG: Functional Abilities and Goals

Self-care

LCDS

GG0130A1

Section GG: Functional Abilities and Goals

Self-care (admission performance) - eating

LCDS

GG0130A2

Section GG: Functional Abilities and Goals

Self-care (discharge goal) - eating

LCDS

GG0130A3

Section GG: Functional Abilities and Goals

Self-care (discharge performance) - eating

LCDS

GG0130B1

Section GG: Functional Abilities and Goals

Self-care (admission performance) - oral hygiene

LCDS

GG0130B2

Section GG: Functional Abilities and Goals

Self-care (discharge goal) - oral hygiene

LCDS

GG0130B3

Section GG: Functional Abilities and Goals

Self-care (discharge performance) - oral hygiene

LCDS

GG0130C1

Section GG: Functional Abilities and Goals

Self-care (admission performance) - toileting hygiene

LCDS

GG0130C2

Section GG: Functional Abilities and Goals

Self-care (discharge goal) - toileting hygiene

LCDS

GG0130C3

Section GG: Functional Abilities and Goals

Self-care (discharge performance) - toileting hygiene

LCDS

GG0130D1

Section GG: Functional Abilities and Goals

Self-care (admission performance) - wash upper body

LCDS

GG0130D2

Section GG: Functional Abilities and Goals

Self-care (discharge goal) - wash upper body

LCDS

GG0130D3

Section GG: Functional Abilities and Goals

Self-care (discharge performance) - wash upper body

LCDS

GG0170

Section GG: Functional Abilities and Goals

Mobility

LCDS

GG0170A1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - roll left and right

LCDS

GG0170A2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - roll left and right

LCDS

GG0170A3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - roll left and right

LCDS

GG0170B1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - sit to lying

LCDS

GG0170B2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - sit to lying

LCDS

GG0170B3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - sit to lying

LCDS

GG0170C1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - lying to sitting on side of bed

LCDS

GG0170C2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - lying to sitting on side of bed

LCDS

GG0170C3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - lying to sitting on side of bed

LCDS

GG0170D1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - sit to stand

LCDS

GG0170D2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - sit to stand

LCDS

GG0170D3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - sit to stand

LCDS

GG0170E1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - chair/bed-to-chair transfer

LCDS

GG0170E2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - chair/bed-to-chair transfer

LCDS

GG0170E3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - chair/bed-to-chair transfer

LCDS

GG0170F1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - toilet transfer

LCDS

GG0170F2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - toilet transfer

LCDS

GG0170F3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - toilet transfer

LCDS

GG0170G1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - car transfer

LCDS

GG0170G2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - car transfer

LCDS

GG0170G3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - car transfer

LCDS

GG0170I1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - walk 10 feet

LCDS

GG0170I2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - walk 10 feet

LCDS

GG0170I3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - walk 10 feet

LCDS

GG0170J1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - walk 50 feet w/2 turns

LCDS

GG0170J2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - walk 50 feet w/2 turns

LCDS

GG0170J3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - walk 50 feet w/2 turns

LCDS

GG0170K1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - walk 150 feet

LCDS

GG0170K2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - walk 150 feet

LCDS

GG0170K3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - walk 150 feet

LCDS

GG0170L1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - walk 10 feet uneven surface

LCDS

GG0170L2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - walk 10 feet uneven surface

LCDS

GG0170L3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - walk 10 feet uneven surface

LCDS

GG0170M1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - 1 step (curb)

LCDS

GG0170M2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - 1 step (curb)

LCDS

GG0170M3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - 1 step (curb)

LCDS

GG0170N1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - 4 steps

LCDS

GG0170N2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - 4 steps

LCDS

GG0170N3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - 4 steps

LCDS

GG0170O1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - 12 steps

LCDS

GG0170O2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - 12 steps

LCDS

GG0170O3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - 12 steps

LCDS

GG0170P1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - picking up object

LCDS

GG0170P2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - picking up object

LCDS

GG0170P3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - picking up object

LCDS

GG0170Q1

Section GG: Functional Abilities and Goals

Does the {patient/resident} use a wheelchair and/or scooter

LCDS

GG0170Q3

Section GG: Functional Abilities and Goals

Does the {patient/resident} use a wheelchair and/or scooter

LCDS

GG0170R1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - wheel 50 feet w/2 turns

LCDS

GG0170R2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - wheel 50 feet w/2 turns

LCDS

GG0170R3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - wheel 50 feet w/2 turns

LCDS

GG0170RR1

Section GG: Functional Abilities and Goals

Indicate the type of wheelchair or scooter used

LCDS

GG0170RR3

Section GG: Functional Abilities and Goals

Indicate the type of wheelchair or scooter used

LCDS

GG0170S1

Section GG: Functional Abilities and Goals

Functional mobility (admission performance) - wheel 150 feet

LCDS

GG0170S2

Section GG: Functional Abilities and Goals

Functional mobility (discharge goal) - wheel 150 feet

LCDS

GG0170S3

Section GG: Functional Abilities and Goals

Functional mobility (discharge performance) - wheel 150 feet

LCDS

GG0170SS1

Section GG: Functional Abilities and Goals

Indicate the type of wheelchair or scooter used

LCDS

GG0170SS3

Section GG: Functional Abilities and Goals

Indicate the type of wheelchair or scooter used

LCDS

H0350

Section H: Bladder and Bowel

Bladder continence

LCDS

H0400

Section H: Bladder and Bowel

Bowel continence

LCDS

I0000

Section I: Active Diagnoses

Active diagnoses (comorbidities and co-existing conditions). Check all that apply

LCDS

I0050

Section I: Active Diagnoses

{Patient/Resident} primary medical condition

LCDS

I0050A

Section I: Active Diagnoses

Other medical condition - ICD code

LCDS

J0510

Section J: Health Conditions

Pain effect on sleep

LCDS

J0520

Section J: Health Conditions

Pain interference with therapy activities

LCDS

J0530

Section J: Health Conditions

Pain interference with day-to-day activities

LCDS

J1800

Section J: Health Conditions

Falls since admission: any falls

LCDS

J1900

Section J: Health Conditions

Number of falls since admission/entry or reentry

LCDS

J1900A

Section J: Health Conditions

Falls since admit/prior assessment: no injury

LCDS

J1900B

Section J: Health Conditions

Falls since admit/prior assessment: injury (except major)

LCDS

J1900C

Section J: Health Conditions

Falls since admit/prior assessment: major injury

LCDS

K0200

Section K: Swallowing/Nutritional Status

Height and weight

LCDS

K0200A

Section K: Swallowing/Nutritional Status

Height (in inches)

LCDS

K0200B

Section K: Swallowing/Nutritional Status

Weight (in pounds)

LCDS

K0520

Section K: Swallowing/Nutritional Status

Nutritional approaches. Check all that apply

LCDS

M0210

Section M: Skin Conditions

Unhealed pressure ulcer(s)/injuries

LCDS

M0300

Section M: Skin Conditions

Current number of unhealed pressure ulcers/injuries at each stage

LCDS

M0300A

Section M: Skin Conditions

Stage 1 pressure injuries: number present

LCDS

M0300A1

Section M: Skin Conditions

Number of stage 1 pressure injuries

LCDS

M0300B

Section M: Skin Conditions

Current number of stage 2 pressure ulcers

LCDS

M0300B1

Section M: Skin Conditions

Stage 2 pressure ulcers: number present

LCDS

M0300B2

Section M: Skin Conditions

Stage 2 pressure ulcers: number at admit/reentry

LCDS

M0300C

Section M: Skin Conditions

Current number of stage 3 pressure ulcers

LCDS

M0300C1

Section M: Skin Conditions

Stage 3 pressure ulcers: number present

LCDS

M0300C2

Section M: Skin Conditions

Stage 3 pressure ulcers: number at admit/reentry

LCDS

M0300D

Section M: Skin Conditions

Current number of stage 4 pressure ulcers

LCDS

M0300D1

Section M: Skin Conditions

Stage 4 pressure ulcers: number present

LCDS

M0300D2

Section M: Skin Conditions

Stage 4 pressure ulcers: number at admit/reentry

LCDS

M0300E

Section M: Skin Conditions

Current number of unstageable: dressing/device pressure ulcers

LCDS

M0300E1

Section M: Skin Conditions

Unstaged due to dressing/device: number present

LCDS

M0300E2

Section M: Skin Conditions

Unstaged due to dressing/device: number at admit/reentry

LCDS

M0300F

Section M: Skin Conditions

Current number of unstageable: slough and/or eschar

LCDS

M0300F1

Section M: Skin Conditions

Unstaged slough/eschar: number present

LCDS

M0300F2

Section M: Skin Conditions

Unstaged slough/eschar: number at admit/reentry

LCDS

M0300G

Section M: Skin Conditions

Current number of unstageable: deep tissue pressure injuries

LCDS

M0300G1

Section M: Skin Conditions

Unstageable - deep tissue injury: number present

LCDS

M0300G2

Section M: Skin Conditions

Unstageable - deep tissue injury: number at admission/reentry

LCDS

N0415

Section N: Medications

High-risk drug classes: use and indication. Check all that apply

LCDS

N2001

Section N: Medications

Drug regimen review

LCDS

N2003

Section N: Medications

Medication follow-up

LCDS

N2005

Section N: Medications

Medication intervention

LCDS

O0110

Section O: Special Treatments, Procedures, and Programs

Special treatments, procedures, and programs. Check all that apply

LCDS

O0150

Section O: Special Treatments, Procedures, and Programs

Spontaneous Breathing Trial (SBT)

LCDS

O0150A

Section O: Special Treatments, Procedures, and Programs

Invasive Mechanical Ventilator Support upon admission

LCDS

O0150A2

Section O: Special Treatments, Procedures, and Programs

Ventilator weaning status

LCDS

O0150B

Section O: Special Treatments, Procedures, and Programs

Assessed for readiness for SBT

LCDS

O0150C

Section O: Special Treatments, Procedures, and Programs

Deemed medically ready for SBT

LCDS

O0150D

Section O: Special Treatments, Procedures, and Programs

Documentation medically unready for SBT

LCDS

O0150E

Section O: Special Treatments, Procedures, and Programs

SBT performed

LCDS

O0200

Section O: Special Treatments, Procedures, and Programs

Ventilator liberation rate

LCDS

O0200A

Section O: Special Treatments, Procedures, and Programs

Invasive Mechanical Ventilator: Liberation Status

LCDS

Z0400

Section Z: Assessment Administration

Signature of persons completing the assessment or entry/death reporting

LCDS

Z0400A

Section Z: Assessment Administration

Signature, title, sections, date section completed A

LCDS

Z0400B

Section Z: Assessment Administration

Signature, title, sections, date section completed B

LCDS

Z0400C

Section Z: Assessment Administration

Signature, title, sections, date section completed C

LCDS

Z0400D

Section Z: Assessment Administration

Signature, title, sections, date section completed D

LCDS

Z0400E

Section Z: Assessment Administration

Signature, title, sections, date section completed E

LCDS

Z0400F

Section Z: Assessment Administration

Signature, title, sections, date section completed F

LCDS

Z0400G

Section Z: Assessment Administration

Signature, title, sections, date section completed G

LCDS

Z0400H

Section Z: Assessment Administration

Signature, title, sections, date section completed H

LCDS

Z0400I

Section Z: Assessment Administration

Signature, title, sections, date section completed I

LCDS

Z0400J

Section Z: Assessment Administration

Signature, title, sections, date section completed J

LCDS

Z0400K

Section Z: Assessment Administration

Signature, title, sections, date section completed K

LCDS

Z0400L

Section Z: Assessment Administration

Signature, title, sections, date section completed L

LCDS

Z0500

Section Z: Assessment Administration

Signature of {RN coordinator} verifying assessment completion

LCDS

Z0500A

Section Z: Assessment Administration

Signature

LCDS

Z0500B

Section Z: Assessment Administration

Date RN signed assessment as complete