LOINC
Version 2.66

89963-3Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 [CMS Assessment]Active

Component
Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 3.0
Property
-
Time
Pt
System
^Patient
Scale
-
Method
CMS Assessment

Panel Hierarchy
Details for each LOINC in Panel LHC-Forms

LOINC Name R/O/C Cardinality Example UCUM Units
89963-3 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 [CMS Assessment]
Indent85395-2 Identification Information
IndentIndent85396-0 Facility Information
IndentIndentIndent76696-4 Facility Name
IndentIndentIndent69417-4 Facility Medicare Provider Number
IndentIndent45397-7 Patient Medicare Number
IndentIndent45400-9 Patient Medicaid Number
IndentIndent45392-8 Patient First Name
IndentIndent45394-4 Patient Last Name
IndentIndent52463-7 Patient Identification Number
IndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndent45396-9 Social Security Number
IndentIndent46098-0 Gender
IndentIndent59362-4 Race/Ethnicity 0..6
IndentIndent45404-1 Marital status
IndentIndent52539-4 Zip Code of Patient's Pre-Hospital Residence
IndentIndent52455-3 Admission Date {mm/dd/yyyy}
IndentIndent52456-1 Assessment Reference Date
IndentIndent85397-8 Admission Class
IndentIndent85398-6 Admit From
IndentIndent85399-4 Pre-hospital Living Setting
IndentIndent85400-0 Pre-hospital Living With
Indent85401-8 Payer information
IndentIndent85813-4 Payment Source
IndentIndentIndent85402-6 Primary Source
IndentIndentIndent85403-4 Secondary Source
Indent87415-6 Medical Information
IndentIndent85405-9 Impairment Group - Admission
IndentIndentIndent85845-6 Impairment Group
IndentIndent85406-7 Impairment Group - Discharge
IndentIndentIndent85845-6 Impairment Group
IndentIndent52797-8 Etiologic Diagnosis 1..3
IndentIndent85585-8 Date of Onset of Impairment {mm/dd/yyyy}
IndentIndent75618-9 Comorbid Conditions 0..25
IndentIndent85407-5 Are there any arthritis conditions recorded in items #21, #22, or #24 that meet all of the regulatory requirements for IRF classification (in 42 CFR 412.29(b)(2)(x), (xi), and (xii))?
IndentIndent54567-3 Height and Weight
IndentIndentIndent3137-7 Height on admission (in inches) [in_us];cm
IndentIndentIndent3141-9 Weight on admission (in pounds) [lb_av];kg
Indent85410-9 Discharge Information
IndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndent85411-7 Patient discharged against medical advice?
IndentIndent85412-5 Program Interruption(s)
IndentIndent85483-6 Program Interruption Dates 0..3
IndentIndentIndent85413-3 Program Interruption Date 1..1 {mm/dd/yyyy}
IndentIndentIndent85414-1 Program Return Date 1..1 {mm/dd/yyyy}
IndentIndent85415-8 Was the patient discharged alive?
IndentIndent55128-3 Patient's discharge destination/living setting
IndentIndent85417-4 Discharge to Living With
IndentIndent85418-2 Diagnosis for Interruption or Death
IndentIndent85419-0 Complications during rehabilitation stay 0..6
Indent85420-8 Therapy Information
IndentIndent85494-3 Week 1: Total Number of Minutes Provided
IndentIndentIndent85566-8 Physical Therapy
IndentIndentIndentIndent85557-7 Total minutes of individual therapy min
IndentIndentIndentIndent85558-5 Total minutes of concurrent therapy min
IndentIndentIndentIndent85559-3 Total minutes of group therapy min
IndentIndentIndentIndent85560-1 Total minutes of co-treatment therapy min
IndentIndentIndent85561-9 Occupational Therapy
IndentIndentIndentIndent85562-7 Total minutes of individual therapy min
IndentIndentIndentIndent85563-5 Total minutes of concurrent therapy min
IndentIndentIndentIndent85564-3 Total minutes of group therapy min
IndentIndentIndentIndent85565-0 Total minutes of co-treatment therapy min
IndentIndentIndent85493-5 Speech-Language Pathology
IndentIndentIndentIndent85492-7 Total minutes of individual therapy min
IndentIndentIndentIndent85491-9 Total minutes of concurrent therapy min
IndentIndentIndentIndent85490-1 Total minutes of group therapy min
IndentIndentIndentIndent85489-3 Total minutes of co-treatment therapy min
IndentIndent85495-0 Week 2: Total Number of Minutes Provided
IndentIndentIndent85589-0 Physical Therapy
IndentIndentIndentIndent85567-6 Total minutes of individual therapy min
IndentIndentIndentIndent85568-4 Total minutes of concurrent therapy min
IndentIndentIndentIndent85569-2 Total minutes of group therapy min
IndentIndentIndentIndent85570-0 Total minutes of co-treatment therapy min
IndentIndentIndent85590-8 Occupational Therapy
IndentIndentIndentIndent85571-8 Total minutes of individual therapy min
IndentIndentIndentIndent85572-6 Total minutes of concurrent therapy min
IndentIndentIndentIndent85573-4 Total minutes of group therapy min
IndentIndentIndentIndent85574-2 Total minutes of co-treatment therapy min
IndentIndentIndent85591-6 Speech-Language Pathology
IndentIndentIndentIndent85575-9 Total minutes of individual therapy min
IndentIndentIndentIndent85576-7 Total minutes of concurrent therapy min
IndentIndentIndentIndent85577-5 Total minutes of group therapy min
IndentIndentIndentIndent85578-3 Total minutes of co-treatment therapy min
Indent88523-6 Quality Indicators - Admission
IndentIndent88522-8 Hearing, Speech, and Vision
IndentIndentIndent83250-1 Expression of Ideas and Wants
IndentIndentIndent87503-9 Understanding Verbal and Non-Verbal Content
IndentIndent88524-4 Cognitive Patterns
IndentIndentIndent83248-5 Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
IndentIndentIndent52491-8 Brief Interview for Mental Status
IndentIndentIndentIndent52731-7 Repetition of Three Words. Number of words repeated after first attempt
IndentIndentIndentIndent54510-3 Temporal Orientation (orientation to year, month, and day)
IndentIndentIndentIndentIndent52732-5 Able to report correct year
IndentIndentIndentIndentIndent52733-3 Able to report correct month
IndentIndentIndentIndentIndent54609-3 Able to report correct day of the week
IndentIndentIndentIndent52493-4 Recall
IndentIndentIndentIndentIndent52735-8 Able to recall "sock"
IndentIndentIndentIndentIndent52736-6 Able to recall "blue"
IndentIndentIndentIndentIndent52737-4 Able to recall "bed"
IndentIndentIndentIndent54614-3 BIMS Summary Score {score}
IndentIndentIndent54615-0 Should the Staff Assessment for Mental Status (C0900) be Conducted?
IndentIndentIndent88521-0 Staff Assessment for Mental Status
IndentIndentIndentIndent88333-0 Memory/Recall Ability 1..4
IndentIndent88482-5 Functional Abilities and Goals - Admission
IndentIndentIndent83239-4 Prior Functioning: Everyday Activities
IndentIndentIndentIndent85070-1 Self-Care
IndentIndentIndentIndent85071-9 Indoor Mobility (Ambulation)
IndentIndentIndentIndent85072-7 Stairs
IndentIndentIndentIndent85073-5 Functional Cognition
IndentIndentIndent83234-5 Prior Device Use 1..5
IndentIndentIndent83233-7 Self-Care - Admission Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent85054-5 Self-Care - Discharge Goal
IndentIndentIndentIndent83231-1 Eating
IndentIndentIndentIndent83229-5 Oral hygiene
IndentIndentIndentIndent83227-9 Toileting hygiene
IndentIndentIndentIndent83225-3 Shower/bathe self
IndentIndentIndentIndent83223-8 Upper body dressing
IndentIndentIndentIndent83221-2 Lower body dressing
IndentIndentIndentIndent83219-6 Putting on/taking off footwear
IndentIndentIndent88330-6 Mobility - Admission Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the patient use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndent85056-0 Mobility - Discharge Goal
IndentIndentIndentIndent83217-0 Roll left and right
IndentIndentIndentIndent83215-4 Sit to lying
IndentIndentIndentIndent83213-9 Lying to sitting on side of bed
IndentIndentIndentIndent83211-3 Sit to stand
IndentIndentIndentIndent83209-7 Chair/Bed-to-chair transfer
IndentIndentIndentIndent83207-1 Toilet transfer
IndentIndentIndentIndent83205-5 Car transfer
IndentIndentIndentIndent83203-0 Walk 10 feet
IndentIndentIndentIndent83201-4 Walk 50 feet with two turns
IndentIndentIndentIndent83199-0 Walk 150 feet
IndentIndentIndentIndent83197-4 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83195-8 1 step (curb)
IndentIndentIndentIndent83193-3 4 steps
IndentIndentIndentIndent83191-7 12 steps
IndentIndentIndentIndent83189-1 Picking up object
IndentIndentIndentIndent83187-5 Wheel 50 feet with two turns
IndentIndentIndentIndent83236-0 Wheel 150 feet
IndentIndent83237-8 Bladder and Bowel
IndentIndentIndent83238-6 Bladder Continence
IndentIndentIndent83242-8 Bowel Continence
IndentIndent83264-2 Active Diagnoses
IndentIndentIndent83243-6 Comorbidities and Co-existing Conditions 1..2
IndentIndent83273-3 Health Conditions - Admission
IndentIndentIndent52552-7 History of Falls. Has the patient had two or more falls in the past year or any fall with injury in the past year?
IndentIndentIndent83274-1 Prior Surgery. Did the resident have major surgery during the 100 days prior to admission?
IndentIndent83244-4 Swallowing/Nutritional Status
IndentIndentIndent83245-1 Swallowing/Nutritional Status 1..3
IndentIndent85055-2 Skin Conditions - Admission
IndentIndentIndent58214-8 Unhealed Pressure Ulcers/Injuries. Does this patient have one or more unhealed pressure ulcers/injuries?
IndentIndentIndent83246-9 Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Admission
IndentIndentIndentIndent54884-2 Number of Stage 1 pressure injuries {#}
IndentIndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndentIndent54893-3 Number of unstageable pressure ulcers/injuries due to non-removable dressing/device {#}
IndentIndentIndentIndent54946-9 Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndentIndentIndent54950-1 Number of unstageable pressure injuries presenting as deep tissue injury {#}
IndentIndent88872-7 Medications
IndentIndentIndent88870-1 Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues?
IndentIndentIndent88871-9 Medication Follow-up: Did the facility contact a physician (or physician-designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential clinically significant medication issues?
IndentIndent83261-8 Special Treatments, Procedures, and Programs - Admission
IndentIndentIndent83252-7 Special Treatments, Procedures, and Programs 0..1
Indent90016-7 Quality Indicators - Discharge
IndentIndent88483-3 Functional Abilities and Goals - Discharge
IndentIndentIndent83254-3 Self-Care - Discharge Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent88331-4 Mobility - Discharge Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the patient use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndent83279-0 Health Conditions - Discharge
IndentIndentIndent83280-8 Any Falls Since Admission. Has the patient had any falls since admission?
IndentIndentIndent54854-5 Number of Falls Since Admission
IndentIndentIndentIndent54855-2 No injury
IndentIndentIndentIndent54856-0 Injury (except major)
IndentIndentIndentIndent54857-8 Major injury
IndentIndent88332-2 Skin Conditions - Discharge
IndentIndentIndent58214-8 Unhealed Pressure Ulcers/Injuries. Does this patient have one or more unhealed pressure ulcers/injuries?
IndentIndentIndent83256-8 Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Discharge
IndentIndentIndentIndent54884-2 Number of Stage 1 pressure injuries {#}
IndentIndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndentIndent54886-7 Number of these Stage 2 pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndentIndent54887-5 Number of these Stage 3 pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndentIndent54890-9 Number of these Stage 4 pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent54893-3 Number of unstageable pressure ulcers/injuries due to non-removable dressing/device {#}
IndentIndentIndentIndent54894-1 Number of these unstageable pressure ulcers/injuries that were present upon admission {#}
IndentIndentIndentIndent54946-9 Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndentIndentIndent54947-7 Number of these unstageable pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent54950-1 Number of unstageable pressure injuries presenting as deep tissue injury {#}
IndentIndentIndentIndent54951-9 Number of these unstageable pressure injuries that were present upon admission {#}
IndentIndent87522-9 Medications
IndentIndentIndent57256-0 Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission?

Term Description

This panel should be used for CMS IRF-PAI v3.0 assessments performed between October 1, 2019 and September 30, 2020.
Source: Regenstrief LOINC

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.65
Last Updated
Version 2.66
Order vs. Observation
Order
Panel Type
Panel

LOINC FHIR® API Example - CodeSystem Request Get Info

https://fhir.loinc.org/CodeSystem/$lookup?system=http://loinc.org&code=89963-3