Form Coding Instructions

Indicate the resident's usual ability with everyday activities prior to the current illness, exacerbation, or injury

Source: Centers for Medicare & Medicaid Services

85070-1 Self-Care

Term Description

Need for assistance with bathing, dressing, using the toilet, and eating prior to the current illness, exacerbation, or injury.

Observation ID in Form

GG0100A

Form Coding Instructions

Code the resident's need for assistance with bathing, dressing, using the toilet, or eating prior to the current illness, exacerbation, or injury

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Prior functioning.self care
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Prior functioning.self care during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Change Component display to match Component, like similar terms
Order vs. Observation
Observation

Normative Answer List LL4970-1

AnswerCodeScoreAnswer ID
Independent - Resident completed all the activities by themself, with or without an assistive device, with no assistance from a helper.3LA28862-3
Needed Some Help - Resident needed partial assistance from another person to complete activities.2LA28863-1
Dependent - A helper completed the activities for the resident.1LA28864-9
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)8LA4489-6
Not applicable9LA4720-4

Member of these Panels

LOINCLong Common Name
103991-6CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
83265-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
87414-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
88329-8Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment]
89963-3Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
88954-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88949-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
90473-0Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care
86189-8Deprecated Outcome and assessment information set (OASIS) form - version C2 - Resumption of care [CMS Assessment]
85907-4Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment]
113114-3Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
103564-1MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104552-5MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104609-3MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
88368-6Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106525-9Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6Respiratory Allergen Panel, Area 5 - Serum

85071-9 Indoor Mobility (Ambulation)

Term Description

Need for assistance with walking from room to room (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury.

Observation ID in Form

GG0100B

Form Coding Instructions

Code the resident's need for assistance with walking from room to room (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Prior functioning.indoor mobility-ambulation
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Indoor mobility (Ambulation) during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
Order vs. Observation
Observation

Normative Answer List LL4970-1

AnswerCodeScoreAnswer ID
Independent - Resident completed all the activities by themself, with or without an assistive device, with no assistance from a helper.3LA28862-3
Needed Some Help - Resident needed partial assistance from another person to complete activities.2LA28863-1
Dependent - A helper completed the activities for the resident.1LA28864-9
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)8LA4489-6
Not applicable9LA4720-4

Member of these Panels

LOINCLong Common Name
103991-6CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
83265-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
87414-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
88329-8Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment]
89963-3Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
85645-0Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment]
87509-6Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
88954-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88949-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
90473-0Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
113114-3Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
103564-1MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104552-5MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104609-3MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
88368-6Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106525-9Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6Respiratory Allergen Panel, Area 5 - Serum

85072-7 Stairs

Term Description

Need for assistance with internal or external stairs (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury.

Observation ID in Form

GG0100C

Form Coding Instructions

Code the resident's need for assistance with internal or external stairs (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Prior functioning.stairs
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Stairs during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
Order vs. Observation
Observation

Normative Answer List LL4970-1

AnswerCodeScoreAnswer ID
Independent - Resident completed all the activities by themself, with or without an assistive device, with no assistance from a helper.3LA28862-3
Needed Some Help - Resident needed partial assistance from another person to complete activities.2LA28863-1
Dependent - A helper completed the activities for the resident.1LA28864-9
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)8LA4489-6
Not applicable9LA4720-4

Member of these Panels

LOINCLong Common Name
103991-6CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
83265-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
87414-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
88329-8Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment]
89963-3Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
88954-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88949-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
90473-0Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
113114-3Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
103564-1MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104552-5MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104609-3MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
88368-6Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106525-9Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6Respiratory Allergen Panel, Area 5 - Serum

85073-5 Functional Cognition

Term Description

Need for assistance with planning regular tasks, such as shopping or remembering to take medication prior to the current illness, exacerbation, or injury.

Observation ID in Form

GG0100D

Form Coding Instructions

Code the resident's need for assistance with planning regular tasks, such as shopping or remembering to take medication prior to the current illness, exacerbation, or injury

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Prior functioning.functional cognition
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Functional cognition during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
Order vs. Observation
Observation

Normative Answer List LL4970-1

AnswerCodeScoreAnswer ID
Independent - Resident completed all the activities by themself, with or without an assistive device, with no assistance from a helper.3LA28862-3
Needed Some Help - Resident needed partial assistance from another person to complete activities.2LA28863-1
Dependent - A helper completed the activities for the resident.1LA28864-9
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)8LA4489-6
Not applicable9LA4720-4

Member of these Panels

LOINCLong Common Name
103991-6CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
83265-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
87414-9Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
88329-8Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment]
89963-3Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
88954-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88949-3Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
90473-0Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
113114-3Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
103564-1MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104552-5MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104609-3MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
88368-6Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106525-9Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6Respiratory Allergen Panel, Area 5 - Serum