Appendix B LTCH Change Table V 2.01 to V 3.00

Change Table: LTCH CARE Data Set V 2.01 to FINAL V 3.00
#

Item Set(s)
Affected
All
Planned
Discharge

Item / Text
Affected
N/A
A2500

3.

Unplanned
Discharge

A2500

4.

Planned
Discharge,
Unplanned
Discharge

A2520

1.
2.

LTCH CARE Data Set V 2.01
Version 2.01
Program Interruption(s)
0. No -> Skip to M0210, Unhealed
Pressure Ulcer(s)
1. Yes -> Continue to A2510, Number of
Program Interruptions During This Stay
in This Facility
Program Interruption(s)
0. No -> Skip to M0210, Unhealed
Pressure Ulcer(s)
1. Yes -> Continue to A2510, Number of
Program Interruptions During This Stay
in This Facility
A2520. Program Interruption Dates.
Code only if A2510 is greater than or
equal to 01.
A1. Most Recent Interruption Start
Date
A2. Most Recent Interruption End Date
B1. Second Most Recent Interruption
Start Date. Code only if A2510 is
greater than 01.
B2. Second Most Recent Interruption
End Date. Code only if A2510 is greater
than 01.
C1. Third Most Recent Interruption
Start Date. Code only if A2510 is
greater than 02.
C2. Third Most Recent Interruption End
Date. Code only if A2510 is greater than
02.

LTCH CARE Data Set V 3.00
Version 3.00
A2500. Program Interruption(s)
Program Interruptions
0. No -> Skip to B0100. Comatose
1. Yes -> Continue to A2510. Number of Program
Interruptions During This Stay in This Facility

Rationale for Change
Updated Version Number
Revised to correct skip
pattern.

A2500. Program Interruption(s)
Program Interruptions
0. No -> Skip to C1610. Signs and Symptoms of
Delirium (from CAM©)
1. Yes -> Continue to A2510. Number of Program
Interruptions During This Stay in This Facility
N/A – delete item A2520. Program Interruption
Dates. Code only if A2510 is greater than or
equal to 01.

Revised to correct skip
pattern.

A2520 is deleted and
replaced with A2525 to
align interruption stay
items with Inpatient
Rehabilitation Facility –
Patient Assessment
Instrument (IRF-PAI).

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Item Set(s)
Affected
Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
A2525

6.

Admission

B0100

B0100. Comatose
Persistent vegetative state/no
discernible consciousness at time of
assessment.
0. No
1. Yes

7.

Planned
Discharge

B0100

N/A – new item

5.

LTCH CARE Data Set V 2.01
N/A - new items

LTCH CARE Data Set V 3.00
A2525. Program Interruption Dates. Code only if
A2510 is greater than or equal to 01.
A1. First Interruption Start Date
A2. First Interruption End Date
B1. Second Interruption Start Date
Code only if A2510 is greater than 01.
B2. Second Interruption End Date
Code only if A2510 is greater than 01.
C1. Third Interruption Start Date
Code only if A2510 is greater than 02.
C2. Third Interruption End Date
Code only if A2510 is greater than 02.
D1. Fourth Interruption Start Date
Code only if A2510 is greater than 03.
D2. Fourth Interruption End Date
Code only if A2510 is greater than 03.
E1. Fifth Interruption Start Date
Code only if A2510 is greater than 04.
E2. Fifth Interruption End Date
Code only if A2510 is greater than 04.
B0100. Comatose
Persistent vegetative state/no discernible
consciousness
0. No -> Continue to BB0700. Expression of Ideas
and Wants
1. Yes -> Skip to GG0100. Prior Functioning:
Everyday Activities
B0100. Comatose
Persistent vegetative state/no discernible
consciousness
0. No -> Continue to BB0700. Expression of Ideas
and Wants
1. Yes -> Skip to GG0130. Self-Care

Rationale for Change
A2520 is deleted and
replaced with A2525 to
align interruption stay
items with IRF-PAI.

Item revised to align with
MDS 3.0. Revised to
correct skip pattern.

New item added to collect
data for function quality
measures. Revised to
correct skip pattern.

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8.

9.

Item Set(s)
Affected
Admission,
Planned
Discharge

Admission,
Planned
Discharge

Item / Text
Affected
BB0700

BB0800

LTCH CARE Data Set V 2.01
N/A – new item

N/A – new item

LTCH CARE Data Set V 3.00
BB0700. Expression of Ideas and Wants (3-day
assessment period)
Expression of ideas and wants (consider both
verbal and non-verbal expression and excluding
language barriers)
4. Expresses complex messages without
difficulty and with speech that is clear and easy
to understand
3. Exhibits some difficulty with expressing needs
and ideas (e.g., some words or finishing
thoughts) or speech is not clear
2. Frequently exhibits difficulty with expressing
needs and ideas
1. Rarely/Never expresses self or speech is very
difficult to understand
BB0800. Understanding Verbal Content (3-day
assessment period)
Understanding Verbal Content (with hearing aid
or device, if used and excluding language
barriers)

Rationale for Change
New item added to collect
data for function quality
measures.

New item added to collect
data for function quality
measures.

4. Understands: Clear comprehension without
cues or repetitions
3. Usually Understands: Understands most
conversations, but misses some part/intent of
message. Requires cues at times to understand
2. Sometimes Understands: Understands only
basic conversations or simple, direct phrases.
Frequently requires cues to understand
1. Rarely/Never Understands

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Item Set(s)
Affected
10. Admission,
Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
C1610A
C1610B
C1610C
C1610D
C1610E
C1610E1
C1610E2

LTCH CARE Data Set V 2.01
N/A – new items

LTCH CARE Data Set V 3.00
C1610. Signs and Symptoms of Delirium (from
CAM©)
Confusion Assessment Method (CAM©)
Shortened Version Worksheet (3-day
assessment period)

Rationale for Change
New items added to
collect data for function
quality measures.

Acute Onset and Fluctuating Course
A. Is there evidence of an acute change in
mental status from the patient's baseline?
B. Did the (abnormal) behavior fluctuate during
the day, that is, tend to come and go or increase
and decrease in severity?
Inattention
C. Did the patient have difficulty focusing
attention, for example, being easily distractible
or having difficulty keeping track of what was
being said?
Disorganized Thinking
D. Was the patient's thinking disorganized or
incoherent, such as rambling or irrelevant
conversation, unclear or illogical flow of ideas,
or unpredictable switching from subject to
subject?
Altered Level of Consciousness
E. Overall, how would you rate the patient's
level of consciousness?
E1. Alert (Normal)
E2. Vigilant (hyperalert) or Lethargic
(drowsy, easily aroused) or Stupor
(difficult to arouse) or Coma
(unarousable)

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Item Set(s)
Affected
11. Admission,
Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected
C1610

12. Admission

Section GG

13. Planned
Discharge
14. Admission

Section GG

Section GG. Functional Status: Usual
Performance
N/A – new section

GG0100B

N/A – new item

N/A

LTCH CARE Data Set V 2.01

LTCH CARE Data Set V 3.00
Adapted with permission from: Inouye SK et al,
Clarifying confusion: The Confusion Assessment
Method. A new method for detection of delirium.
Annals of Internal Medicine. 1990; 113: 941-948.
Confusion Assessment Method: Training Manual
and Coding Guide, Copyright 2003, Hospital
Elder Life Program, LLC. Not to be reproduced
without permission.
Section GG. Functional Abilities and Goals
Section GG. Functional Abilities and Goals
GG0100. Prior Functioning: Everyday Activities.
Indicate the patient’s usual ability with everyday
activities prior to the current illness,
exacerbation, or injury.

Rationale for Change
New language added to
indicate CAM© items are
used in the LTCH CARE
Data Set with permission
from copyright holder.

Revised label to align with
MDS 3.0 and IRF-PAI.
Revised label to align with
MDS 3.0 and IRF-PAI.
New item added to collect
data for function quality
measures.

B. Indoor Mobility (Ambulation): Code the
patient’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.
3. Independent - Patient completed the
activities by him/herself, with or without an
assistive device, with no assistance from a
helper.
2. Needed Some Help - Patient needed partial
assistance from another person to complete
activities.
1. Dependent - A helper completed the activities
for the patient.
8. Unknown
9. Not Applicable
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Item Set(s)
Affected
15. Admission

Item / Text
Affected
GG0110A
GG0110B
GG0110C
GG0110Z

LTCH CARE Data Set V 2.01
N/A – new items

LTCH CARE Data Set V 3.00
GG0110. Prior Device Use. Indicate devices and
aids used by the patient prior to the current
illness, exacerbation, or injury.

16. Admission

GG0130
GG0170

N/A – new label

Check all that apply
A. Manual wheelchair
B. Motorized wheelchair or scooter
C. Mechanical lift
Z. None of the above
1. Admission Performance

17. Admission

GG0130
GG0170

N/A – new label

2. Discharge Goal

18. Planned
Discharge

GG0130
GG0170

N/A – new label

3. Discharge Performance

19. Admission

GG0130A
GG0130B
GG0130C
GG0130D

N/A – new items

GG0130. Self-Care (3-day assessment period)
Code the patient's usual performance at
admission for each activity using the 6-point
scale. If activity was not attempted at
admission, code the reason. Code the patient's
discharge goal(s) using the 6-point scale. Do not
use codes 07, 09, or 88 to code discharge
goal(s).

Rationale for Change
New items added to
collect data for function
quality measures.

New label to indicate
patient’s usual
performance at
admission.
New label to indicate
patient’s discharge
goal(s).
New label to indicate
patient’s usual
performance at discharge.
New items added to
collect data for function
quality measures.

Admission Performance and Discharge Goal
A. Eating: The ability to use suitable utensils to
bring food to the mouth and swallow food once
the meal is presented on a table/tray. Includes
modified food consistency.

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Item Set(s)
Affected

20. Planned
Discharge

Item / Text
Affected

GG0130A
GG0130B
GG0130C
GG0130D

LTCH CARE Data Set V 2.01

N/A – new items

LTCH CARE Data Set V 3.00
B. Oral hygiene: The ability to use suitable items
to clean teeth. [Dentures (if applicable): The
ability to remove and replace dentures from and
to the mouth, and manage equipment for
soaking and rinsing them.]
C. Toileting hygiene: The ability to maintain
perineal hygiene, adjust clothes before and after
using the toilet, commode, bedpan or urinal. If
managing an ostomy, include wiping the
opening but not managing equipment.
D. Wash upper body: The ability to wash, rinse,
and dry the face, hands, chest, and arms while
sitting in a chair or bed.
GG0130. Self-Care (3-day assessment period)
Code the patient's usual performance at
discharge for each activity using the 6-point
scale. If an activity was not attempted at
discharge, code the reason.

Rationale for Change

New items added to
collect data for function
quality measures.

Discharge Performance
A. Eating: The ability to use suitable utensils to
bring food to the mouth and swallow food once
the meal is presented on a table/tray. Includes
modified food consistency.
B. Oral hygiene: The ability to use suitable items
to clean teeth. [Dentures (if applicable): The
ability to remove and replace dentures from and
to the mouth, and manage equipment for
soaking and rinsing them.]
C. Toileting hygiene: The ability to maintain
perineal hygiene, adjust clothes before and after
using the toilet, commode, bedpan or urinal. If
managing an ostomy, include wiping the
opening but not managing equipment.
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Item Set(s)
Affected

Item / Text
Affected

21. Admission

GG0160A
GG0160B
GG0160C

22. Admission

GG0170A
GG0170B
GG0170C
GG0170D
GG0170E
GG0170F
GG0170H1
GG0170I
GG0170J
GG0170K
GG0170Q1
GG0170R
GG0170RR1
GG0170S
GG0170SS1

LTCH CARE Data Set V 2.01

GG0160. Functional Mobility
(Complete during the 3-day assessment
period.)
A. Roll left and right: The ability to roll
from lying on back to left and right
side, and roll back to back.
B. Sit to lying: The ability to move from
sitting on side of bed to lying flat on
the bed.
C. Lying to sitting on side of bed: The
ability to safely move from lying on the
back to sitting on the side of the bed
with feet flat on the floor, no back
support.
N/A – new items

LTCH CARE Data Set V 3.00
D. Wash upper body: The ability to wash, rinse,
and dry the face, hands, chest, and arms while
sitting in a chair or bed.
N/A – delete item GG0160. Functional Mobility
(Complete during the 3-day assessment period.)

GG0170. Mobility (3-day assessment period)
Code the patient's usual performance at
admission for each activity using the 6-point
scale. If activity was not attempted at
admission, code the reason. Code the patient's
discharge goal(s) using the 6-point scale. Do not
use codes 07, 09, or 88 to code discharge
goal(s).

Rationale for Change

Items GG0160A, B, and C
are deleted and replaced
with Section GG
Functional Abilities and
Goals and items
GG0170A, B, and C.

New items added to
collect data for function
quality measures.
GG0170A, B, and C
replaced GG0160A, B, and
C.

Admission Performance and Discharge Goal
A. Roll left and right: The ability to roll from
lying on back to left and right side, and return to
lying on back.
B. Sit to lying: The ability to move from sitting
on side of bed to lying flat on the bed.

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Item Set(s)
Affected

Item / Text
Affected

LTCH CARE Data Set V 2.01

LTCH CARE Data Set V 3.00
C. Lying to sitting on side of bed: The ability to
safely move from lying on the back to sitting on
the side of the bed with feet flat on the floor,
and with no back support.
D. Sit to stand: The ability to safely come to a
standing position from sitting in a chair or on the
side of the bed.
E. Chair/bed-to-chair transfer: The ability to
safely transfer to and from a bed to a chair (or
wheelchair).
F. Toilet transfer: The ability to safely get on and
off a toilet or commode.
H1. Does the patient walk?
0. No, and walking goal is not clinically
indicated -> Skip to GG0170Q1. Does the
patient use a wheelchair/scooter?
1. No, and walking goal is clinically
indicated -> Code the patient's Discharge
Goal(s) for items GG0170I, J, and K. For
Admission Performance, skip to
GG0170Q1. Does the patient use a
wheelchair/scooter?
2. Yes -> Continue to GG0170I. Walk 10
feet
I. Walk 10 feet: Once standing, the ability to
walk at least 10 feet in a room, corridor or
similar space.
J. Walk 50 feet with two turns: Once standing,
the ability to walk 50 feet and make two turns.
K. Walk 150 feet: Once standing, the ability to
walk at least 150 feet in a corridor or similar
space.

Rationale for Change

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Item Set(s)
Affected

23. Planned
Discharge

Item / Text
Affected

LTCH CARE Data Set V 2.01

GG0170A
N/A – new items
GG0170B
GG0170C
GG0170D
GG0170E
GG0170F
GG0170H3
GG0170I
GG0170J
GG0170K
GG0170Q3
GG0170R
GG0170RR3

LTCH CARE Data Set V 3.00
Q1. Does the patient use a wheelchair/scooter?
0. No -> Skip to H0350. Bladder
Continence
1. Yes -> Continue to GG0170R. Wheel
50 feet with two turns
R. Wheel 50 feet with two turns: Once seated in
wheelchair/scooter, the ability to wheel at least
50 feet and make two turns.
RR1. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
S. Wheel 150 feet: Once seated in
wheelchair/scooter, the ability to wheel at least
150 feet in a corridor or similar space.
SS1. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
GG0170. Mobility (3-day assessment period)
Code the patient's usual performance at
discharge for each activity using the 6-point
scale. If an activity was not attempted at
discharge, code the reason.

Rationale for Change

New items added to
planned discharge to
collect data for function
quality measures.

Discharge Performance
A. Roll left and right: The ability to roll from
lying on back to left and right side, and return to
lying on back.
B. Sit to lying: The ability to move from sitting
on side of bed to lying flat on the bed.

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Item Set(s)
Affected

Item / Text
Affected
GG0170S
GG0170SS3

LTCH CARE Data Set V 2.01

LTCH CARE Data Set V 3.00
C. Lying to sitting on side of bed: The ability to
safely move from lying on the back to sitting on
the side of the bed with feet flat on the floor,
and with no back support.
D. Sit to stand: The ability to safely come to a
standing position from sitting in a chair or on the
side of the bed.
E. Chair/bed-to-chair transfer: The ability to
safely transfer to and from a bed to a chair (or
wheelchair).
F. Toilet transfer: The ability to safely get on and
off a toilet or commode.
H3. Does the patient walk?
0. No -> Skip to GG0170Q3. Does the
patient use a wheelchair/scooter?
2. Yes -> Continue to GG0170I. Walk 10
feet
I. Walk 10 feet: Once standing, the ability to
walk at least 10 feet in a room, corridor or
similar space.
J. Walk 50 feet with two turns: Once standing,
the ability to walk 50 feet and make two turns.
K. Walk 150 feet: Once standing, the ability to
walk at least 150 feet in a corridor or similar
space.
Q3. Does the patient use a wheelchair/scooter?
0. No -> Skip to H0350. Bladder
Continence
1. Yes -> Continue to GG0170R. Wheel
50 feet with two turns

Rationale for Change

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Item Set(s)
Affected

24. Admission,
Planned
Discharge

Item / Text
Affected

H0350

LTCH CARE Data Set V 2.01

N/A – new item

LTCH CARE Data Set V 3.00
R. Wheel 50 feet with two turns: Once seated in
wheelchair/scooter, the ability to wheel at least
50 feet and make two turns.
RR3. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
S. Wheel 150 feet: Once seated in
wheelchair/scooter, the ability to wheel at least
150 feet in a corridor or similar space.
SS3. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
H0350. Bladder Continence (3-day assessment
period)
Bladder continence - Select the one category
that best describes the patient.

Rationale for Change

New items added to
collect data for function
quality measures.

0. Always continent (no documented
incontinence)
1. Stress incontinence only
2. Incontinent less than daily (e.g., once or
twice during the 3-day assessment period)
3. Incontinent daily (at least once a day)
4. Always incontinent
5. No urine output (e.g., renal failure)
9. Not applicable (e.g., indwelling catheter)

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Item Set(s)
Affected
25. Admission

Item / Text
Affected
H0400

26. Admission

LTCH CARE Data Set V 2.01
H0400. Bowel Continence
(Complete during the 3-day assessment
period.)

LTCH CARE Data Set V 3.00
H0400. Bowel Continence (3-day assessment
period)

I0050

N/A – new item

27. Admission

I0050A

N/A – new item

I0050. Indicate the patient's primary medical
condition category.
Indicate the patient's primary medical
condition category.
1. Acute onset respiratory condition (e.g.,
aspiration and specified bacterial pneumonias)
2. Chronic respiratory condition (e.g., chronic
obstructive pulmonary disease)
3. Acute onset and chronic respiratory
conditions
4. Chronic cardiac condition (e.g., heart failure)
5. Other medical condition If “other medical
condition”, enter the ICD code in the boxes.
I0050A.
[ICD code]

28. Admission

I0101

N/A – new items

I1501
I1502
I2101
I2600

Comorbidities and Co-existing Conditions
Check all that apply
Cancers
I0101. Severe and Metastatic Cancers

I4100

Genitourinary
I1501. Chronic Kidney Disease, Stage 5
I1502. Acute Renal Failure

I4501
I4801
I4900

Infections
I2101. Septicemia, Sepsis, Systemic
Inflammatory Response Syndrome/Shock

Rationale for Change
Revised to align with
similar language used
across LTCH CARE Data
Set V 3.00.
New items added to
collect data for function
quality measures.

New item added to collect
data for function quality
measures.
New items added to
collect data for function
quality measures.

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Item Set(s)
Affected

Item / Text
Affected
I5000
I5101
I5102
I5110
I5200
I5250
I5300
I5450
I5460
I5470
I7900

LTCH CARE Data Set V 2.01

LTCH CARE Data Set V 3.00
I2600. Central Nervous System Infections,
Opportunistic Infections, Bone/Joint/Muscle
Infections/Necrosis

Rationale for Change

Musculoskeletal
I4100. Major Lower Limb Amputation (e.g.,
above knee, below knee)
Neurological
I4501. Stroke
I4801. Dementia
I4900. Hemiplegia or Hemiparesis
I5000. Paraplegia
I5101. Complete Tetraplegia
I5102. Incomplete Tetraplegia
I5110. Other Spinal Cord Disorder/Injury (e.g.,
myelitis, cauda equina syndrome)
I5200. Multiple Sclerosis (MS)
I5250. Huntington's Disease
I5300. Parkinson's Disease
I5450. Amyotrophic Lateral Sclerosis
I5460. Locked-In State
I5470. Severe Anoxic Brain Damage, Cerebral
Edema, or Compression of Brain
None of the Above
I7900. None of the above

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Item Set(s)
Affected
29. Admission

Item / Text
Affected
I5600
I5601

30. Planned
Discharge,
Unplanned
Discharge

J1800

LTCH CARE Data Set V 2.01
Nutritional
I5600. Malnutrition (protein or calorie)
or at risk for malnutrition
N/A – new item

31. Expired

J1800

N/A – new item

32. Planned
Discharge,
Unplanned
Discharge,
Expired

J1900A
J1900B
J1900C

N/A – new item

LTCH CARE Data Set V 3.00
Nutritional
I5601. Malnutrition (protein or calorie)
I5602. At Risk for Malnutrition
J1800. Any Falls Since Admission
Has the patient had any falls since admission?
0. No -> Skip to M0210. Unhealed Pressure
Ulcer(s)
1. Yes -> Continue to J1900. Number of
Falls Since Admission
J1800. Any Falls Since Admission
Has the patient had any falls since admission?
0. No -> Skip to O0250. Influenza Vaccine
1. Yes -> Continue to J1900. Number of
Falls Since Admission
J1900. Number of Falls Since Admission
A. No injury: No evidence of any injury is
noted on physical assessment by the
nurse or primary care clinician; no
complaints of pain or injury by the
patient; no change in the patient's
behavior is noted after the fall
B. Injury (except major): Skin tears,
abrasions, lacerations, superficial
bruises, hematomas and sprains; or any
fall-related injury that causes the patient
to complain of pain
C. Major injury: Bone fractures, joint
dislocations, closed head injuries with
altered consciousness, subdural
hematoma

Rationale for Change
I5600 is deleted and
replaced with I5601 and
I5602.
New items added to
collect data for falls
quality measure.

New items added to
collect data for falls with
major injury quality
measure. Revised skip
pattern to accommodate
new items added to the
Expired Assessment.
New item added to collect
data for falls with major
injury quality measure.

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Item Set(s)
Affected
33. Admission

Item / Text
Affected
K0200B

34. Admission

M0210

35. Admission

M0300B1
M0300C1
M0300D1
M0300E1
M0300F1

LTCH CARE Data Set V 2.01
B. Weight (in pounds). Base weight on
most recent measure in last 3 days;
measure weight consistently, according
to standard facility practice (e.g., in
a.m. after voiding, before meal, with
shoes off, etc.)
M0210. Unhealed Pressure Ulcer(s).
Does this patient have one or more
unhealed pressure ulcer(s) at Stage 1
or higher?
0. No -> Skip to O0250, Influenza
Vaccine.
1. Yes -> Continue to M0300, Current
Number of Unhealed Pressure Ulcers at
Each Stage.
M0300B1. Number of Stage 2 pressure
ulcers- If 0 -> Skip to M0300C, Stage 3

LTCH CARE Data Set V 3.00
B. Weight (in pounds). Base weight on most
recent measure in last 3 days; measure weight
consistently, according to standard facility
practice (e.g., in a.m. after voiding, before meal,
with shoes off).

Rationale for Change
Revised item language to
remove “etc.”

M0210. Unhealed Pressure Ulcer(s)
Does this patient have one or more unhealed
pressure ulcer(s) at Stage 1 or higher?
0. No -> Skip to O0100. Special Treatments,
Procedures, and Programs
1. Yes -> Continue to M0300. Current Number of
Unhealed Pressure Ulcers at Each Stage

Revised to correct skip
pattern.

N/A – deleted skip pattern following each item
noted below:

M0300C1. Number of Stage 3
pressure ulcers- If 0 -> Skip to
M0300D, Stage 4

M0300B1. Number of Stage 2 pressure ulcers

Revised items on
admission to address new
skip pattern due to item
change.

M0300D1. Number of Stage 4 pressure
ulcers- If 0 -> Skip to M0300E,
Unstageable: Nonremovable
dressing/device

M0300D1. Number of Stage 4 pressure ulcers

M0300E1. Number of unstageable
pressure ulcers due to nonremovable
dressing/device- If 0 ->Skip to M0300F,
Unstageable: Slough and/or eschar

M0300F1. Number of unstageable pressure
ulcers due to coverage of wound bed by slough
and/or eschar

M0300C1. Number of Stage 3 pressure ulcers

M0300E1. Number of unstageable pressure
ulcers due to non-removable dressing/device

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Item Set(s)
Affected

36. Admission

37. Planned
Discharge,
Unplanned
Discharge

Item / Text
Affected

M0300B2
M0300C2
M0300D2
M0300E2
M0300F2
M0300G2
M0300B1
M0300C1
M0300D1
M0300E1
M0300F1
M0300G1

LTCH CARE Data Set V 2.01
M0300F1. Number of unstageable
pressure ulcers due to coverage of
wound bed by slough and/or eschar- If
0 -> Skip to M0300G, Unstageable:
Deep tissue injury
M0300G1. Number of unstageable
pressure ulcers with suspected deep
tissue injury in evolution - If 0 -> Skip
to O0250, Influenza Vaccine
M0300. Number of these Stage X
pressure ulcers that were present
upon admission - enter how many
were noted at the time of admission
M0300B1. Number of Stage 2 pressure
ulcers - If 0 ->
Skip to M0300C, Stage 3
M0300C1. Number of Stage 3 pressure
ulcers- If 0 -> Skip to M0300D, Stage 4
M0300D1. Number of Stage 4 pressure
ulcers - If 0 ->
Skip to M0300E, Unstageable:
Nonremovable dressing
M0300E1. Number of unstageable
pressure ulcers due to nonremovable
dressing/device - If 0 -> Skip to
M0300F, Unstageable: Slough and/or
eschar

LTCH CARE Data Set V 3.00
M0300G1. Number of unstageable pressure
ulcers with suspected deep tissue injury in
evolution

Rationale for Change

N/A – deleted items: M0300B2-C2-D2-E2-F2-G2
and associated text

Items are deleted to
reduce burden associated
with duplicative items.

M0300B1. Number of Stage 2 pressure ulcers If 0 -> Skip to M0300C. Stage 3

Revised to align with
similar formatting used
across LTCH CARE Data
Set V 3.0.

M0300C1. Number of Stage 3 pressure ulcers- If
0 -> Skip to M0300D. Stage 4
M0300D1. Number of Stage 4 pressure ulcers If 0 -> Skip to M0300E. Unstageable - Nonremovable dressing

M0300G1 is revised to
correct skip pattern.

M0300E1. Number of unstageable pressure
ulcers due to non-removable dressing/device If 0 -> Skip to M0300F. Unstageable - Slough
and/or eschar

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Item Set(s)
Affected

Item / Text
Affected

38. Planned
Discharge,
Unplanned
Discharge

M0800

39. Admission

O0100F3
O0100F4
O0100G
O0100J
O0100N
O0100Z

LTCH CARE Data Set V 2.01
M0300F1. Number of unstageable
pressure ulcers due to coverage of
wound bed by slough and/or eschar If 0 -> Skip to M0300G, Unstageable:
Deep tissue injury
M0300G1. Number of unstageable
pressure ulcers with suspected deep
tissue injury in evolution - If 0 ->
Skip to M0800, Worsening in Pressure
Ulcer Status Since Prior Assessment
M0800. Worsening in Pressure Ulcer
Status Since Prior Assessment
Indicate the number of current
pressure ulcers that were not present
or were at a lesser stage on prior
assessment. If no current pressure
ulcer at a given stage, enter 0
A. Stage 2
B. Stage 3
C. Stage 4
N/A – new items

LTCH CARE Data Set V 3.00
M0300F1. Number of unstageable pressure
ulcers due to coverage of wound bed by slough
and/or eschar - If 0 -> Skip to M0300G.
Unstageable - Deep tissue injury

Rationale for Change

M0300G1. Number of unstageable pressure
ulcers with suspected deep tissue injury in
evolution - If 0 -> Skip to M0800. Worsening in
Pressure Ulcer Status Since Admission
M0800. Worsening in Pressure Ulcer Status
Since Admission
Indicate the number of current pressure ulcers
that were not present or were at a lesser stage
on admission. If no current pressure ulcer at a
given stage, enter 0
A. Stage 2
B. Stage 3
C. Stage 4
D. Unstageable - Non-removable dressing
E. Unstageable - Slough and/or eschar
F. Unstageable - Deep tissue injury
O0100. Special Treatments, Procedures, and
Programs
Check all the treatments at admission. For
dialysis, check if it is part of the patient’s
treatment plan.

Revised item. Added
M0800D, E, and F to
support measure
development.

New items added to
collect data for function
quality measures.

Check all that apply
Respiratory Treatments
F3. Invasive Mechanical Ventilator: weaning
F4. Invasive Mechanical Ventilator: nonweaning
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Item Set(s)
Affected

Item / Text
Affected

LTCH CARE Data Set V 2.01

LTCH CARE Data Set V 3.00
G. Non-invasive Ventilator (BIPAP, CPAP)

Rationale for Change

Other Treatments
J. Dialysis
N. Total Parenteral Nutrition

40. Expired

O0250A
O0250B
O0250C

N/A – new items

None of the Above
Z. None of the above
O0250. Influenza Vaccine - Refer to current
version of LTCH Quality Reporting Program
Manual for current influenza season and
reporting period.
A. Did the patient receive the influenza vaccine
in this facility for this year’s influenza
vaccination season?
0. No -> Skip to O0250C. If Influenza vaccine not
received, state reason
1. Yes -> Continue to O0250B. Date influenza
vaccine received

Added O0250 items to
Expired Assessment to
collect data for influenza
vaccination quality
measure.

B. Date influenza vaccine received -> Complete
date and skip to Z0400. Signature of Persons
Completing the Assessment
C. If influenza vaccine received, state reason:
1. Patient not in this facility during this year’s
influenza vaccination season
2. Received outside of this facility
3. Not eligible - medical contradiction
4. Offered and declined
5. Not offered
6. Inability to obtain influenza vaccine due to a
declared shortage
9. None of the above
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Item Set(s)
Affected
41. All

Item / Text
Affected
Burden
Estimate in
PRA
Disclosure
Statement

LTCH CARE Data Set V 2.01
Admission Assessment – 16 minutes
Planned Discharge Assessment – 16
minutes
Unplanned Discharge Assessment – 16
minutes
Expired Assessment – 10 minutes

LTCH CARE Data Set V 3.00
Admission Assessment – 30 minutes
Planned Discharge Assessment – 30 minutes
Unplanned Discharge Assessment – 30 minutes
Expired Assessment – 20 minutes

Rationale for Change
Updated burden
estimates by 14 minutes
on the Admission,
Planned Discharge, and
Unplanned Discharge
Assessments and by 10
minutes on the Expired
Assessment to account
for additional items on V
3.00.

Page 20 of 20