LOINC
Version 2.71

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

Term Description

This panel should be used for CMS IRF-PAI v3.0 assessments performed since October 1, 2019. The effective date of new versions of this form (e.g. v4.0) have been delayed due to the COVID-19 PHE. For the latest information, please see announcements on https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Spotlight-Announcements.
Source: Regenstrief LOINC

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;m
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
Indent96298-5 Quality Indicators - Admission
IndentIndent95943-7 Hearing, Speech, and Vision
IndentIndentIndent95737-3 Expression of Ideas and Wants
IndentIndentIndent95740-7 Understanding Verbal and Non-Verbal Content
IndentIndent96299-3 Cognitive Patterns
IndentIndentIndent54605-1 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?
IndentIndentIndent95944-5 Staff Assessment for Mental Status
IndentIndentIndentIndent95743-1 Memory/Recall Ability 1..4
IndentIndent95811-6 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
IndentIndentIndent95732-4 Self-Care - Admission Performance
IndentIndentIndentIndent95019-6 Eating
IndentIndentIndentIndent95018-8 Oral hygiene
IndentIndentIndentIndent95017-0 Toileting hygiene
IndentIndentIndentIndent95015-4 Shower/bathe self
IndentIndentIndentIndent95014-7 Upper body dressing
IndentIndentIndentIndent95013-9 Lower body dressing
IndentIndentIndentIndent95012-1 Putting on/taking off footwear
IndentIndentIndent89478-2 Self-Care - Discharge Goal
IndentIndentIndentIndent89409-7 Eating
IndentIndentIndentIndent89404-8 Oral hygiene
IndentIndentIndentIndent89389-1 Toileting hygiene
IndentIndentIndentIndent89396-6 Shower/bathe self
IndentIndentIndentIndent89387-5 Upper body dressing
IndentIndentIndentIndent89406-3 Lower body dressing
IndentIndentIndentIndent89400-6 Putting on/taking off footwear
IndentIndentIndent95741-5 Mobility - Admission Performance
IndentIndentIndentIndent95011-3 Roll left and right
IndentIndentIndentIndent95010-5 Sit to lying
IndentIndentIndentIndent95009-7 Lying to sitting on side of bed
IndentIndentIndentIndent95008-9 Sit to stand
IndentIndentIndentIndent95007-1 Chair/bed-to-chair transfer
IndentIndentIndentIndent95006-3 Toilet transfer
IndentIndentIndentIndent95005-5 Car transfer
IndentIndentIndentIndent95004-8 Walk 10 feet
IndentIndentIndentIndent95003-0 Walk 50 feet with two turns
IndentIndentIndentIndent95002-2 Walk 150 feet
IndentIndentIndentIndent95001-4 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent95000-6 1 step (curb)
IndentIndentIndentIndent94999-0 4 steps
IndentIndentIndentIndent94998-2 12 steps
IndentIndentIndentIndent94997-4 Picking up object
IndentIndentIndentIndent95738-1 Does the patient use a wheelchair and/or scooter?
IndentIndentIndentIndent94992-5 Wheel 50 feet with two turns
IndentIndentIndentIndent95739-9 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent94991-7 Wheel 150 feet
IndentIndentIndentIndent95739-9 Indicate the type of wheelchair or scooter used
IndentIndentIndent89476-6 Mobility - Discharge Goal
IndentIndentIndentIndent89398-2 Roll left and right
IndentIndentIndentIndent89394-1 Sit to lying
IndentIndentIndentIndent85927-2 Lying to sitting on side of bed
IndentIndentIndentIndent89392-5 Sit to stand
IndentIndentIndentIndent89414-7 Chair/bed-to-chair transfer
IndentIndentIndentIndent89390-9 Toilet transfer
IndentIndentIndentIndent89412-1 Car transfer
IndentIndentIndentIndent89385-9 Walk 10 feet
IndentIndentIndentIndent89381-8 Walk 50 feet with two turns
IndentIndentIndentIndent89383-4 Walk 150 feet
IndentIndentIndentIndent89379-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent89420-4 1 step (curb)
IndentIndentIndentIndent89416-2 4 steps
IndentIndentIndentIndent89418-8 12 steps
IndentIndentIndentIndent89402-2 Picking up object
IndentIndentIndentIndent89375-0 Wheel 50 feet with two turns
IndentIndentIndentIndent89377-6 Wheel 150 feet
IndentIndent95733-2 Bladder and Bowel
IndentIndentIndent95735-7 Bladder Continence
IndentIndentIndent95736-5 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?
IndentIndent95945-2 Swallowing/Nutritional Status
IndentIndentIndent95946-0 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 {#}
IndentIndent87521-1 Medications
IndentIndentIndent57255-2 Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues?
IndentIndentIndent57281-8 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
IndentIndent95810-8 Functional Abilities and Goals - Discharge
IndentIndentIndent95734-0 Self-Care - Discharge Performance
IndentIndentIndentIndent95019-6 Eating
IndentIndentIndentIndent95018-8 Oral hygiene
IndentIndentIndentIndent95017-0 Toileting hygiene
IndentIndentIndentIndent95015-4 Shower/bathe self
IndentIndentIndentIndent95014-7 Upper body dressing
IndentIndentIndentIndent95013-9 Lower body dressing
IndentIndentIndentIndent95012-1 Putting on/taking off footwear
IndentIndentIndent95742-3 Mobility - Discharge Performance
IndentIndentIndentIndent95011-3 Roll left and right
IndentIndentIndentIndent95010-5 Sit to lying
IndentIndentIndentIndent95009-7 Lying to sitting on side of bed
IndentIndentIndentIndent95008-9 Sit to stand
IndentIndentIndentIndent95007-1 Chair/bed-to-chair transfer
IndentIndentIndentIndent95006-3 Toilet transfer
IndentIndentIndentIndent95005-5 Car transfer
IndentIndentIndentIndent95004-8 Walk 10 feet
IndentIndentIndentIndent95003-0 Walk 50 feet with two turns
IndentIndentIndentIndent95002-2 Walk 150 feet
IndentIndentIndentIndent95001-4 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent95000-6 1 step (curb)
IndentIndentIndentIndent94999-0 4 steps
IndentIndentIndentIndent94998-2 12 steps
IndentIndentIndentIndent94997-4 Picking up object
IndentIndentIndentIndent95738-1 Does the person use a motorized wheelchair and/or scooter?
IndentIndentIndentIndent94992-5 Wheel 50 feet with two turns
IndentIndentIndentIndent95739-9 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent94991-7 Wheel 150 feet
IndentIndentIndentIndent95739-9 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?

Fully-Specified Name

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

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.65
Last Updated
Version 2.69
Order vs. Observation
Order
Panel Type
Panel

LOINC FHIR® API Example - CodeSystem and Questionnaire Requests Get Info

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