The anticipated October 1, 2018, changes to the MDS include a number of additions to section GG, according to technical specifications published in December by the Centers for Medicare & Medicaid Services (CMS). Additional data to be required in section GG will necessitate increased collaboration between nursing and therapy. As you may recall, section GG is a response to the IMPACT Act, and not collecting enough data may negatively impact your annual percentage update by as much as 2% of your reimbursement. Here is what you need to know.
Capture Resident’s Function Prior to Admission
(Note: The new items listed below appear in both the Admission and Discharge assessments.)
GG0100. Prior Functioning: Everyday Activities—Indicate the resident’s usual ability with everyday activities prior to the current illness, exacerbation, or injury.
This item comes with its own new coding set:
3. Independent—Resident completed the activities by him/herself, with or without an assistive device, with no assistance from a helper.
2. Needed Some Help—Resident needed partial assistance from another person to complete activities.
1. Dependent—A helper completed the activities for the resident.
9. Not Applicable.
GG0100A. Self-Care: Code the resident's need for assistance with bathing, dressing, using the toilet, or eating prior to the current illness, exacerbation, or injury.
GG0100B. Indoor Mobility (Ambulation): 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.
GG0100C. Stairs: 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.
GG0100D. Functional Cognition: 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.
GG0110. Prior Device Use. Indicate devices and aids used by the resident prior to the current illness, exacerbation, or injury. This section includes manual wheelchair, motorized wheelchair and/or scooter, mechanical lift, walker, orthotics/prosthetics, none of the above.
New Coding Level and Items Added to Self-Care and Mobility
In the coding sets for GG0130, Self-Care, and GG0170, Mobility, a new coding level was added: 10, Not attempted due to environment limitations (e.g., lack of equipment, weather constraints).
GG0130E. Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower.
GG0130F. Upper body dressing: The ability to dress and undress above the waist, including fasteners, if applicable.
GG0130G. Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear.
GG0130H. Putting on/taking off footwear: The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility, including fasteners, if applicable.
GG0170A. Roll left and right: The ability to roll from lying on back to left and right side, and return to lying on back on the bed.
GG0170G. Car transfer: The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt.
GG0170I. Walk 10 feet: Once standing, the ability to walk at least 10 feet in a room, corridor, or similar space.
GG0170L. Walk 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel.
GG0170M. 1 step (curb): The ability to go up and down a curb and/or up and down one step.
GG0170N. 4 steps: The ability to go up and down four steps with or without a rail.
GG0170O. 12 steps: The ability to go up and down 12 steps with or without a rail.
GG0170P. Picking up object: The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor.
As you can see, all of the new items are function focused, and most are well suited to being captured by your therapy team. That doesn’t mean that section GG should be done by only your therapy team. If you think back to when section GG was first implemented, CMS indicated that the coded level captured should be the “usual performance” prior to any treatment intervention. Following the implementation, AANAC produced several tools (see the Section GG Data Collection Tool and Section GG Data Collection Tool II) and published recommendations for collecting that information. (The tools will be updated to reflect the MDS changes before the October 1, 2018, implementation date.)
While it is easy to allow therapy or nursing alone to capture the section GG items, I would caution against this. Therapists are highly skilled in capturing such data, but residents often behave differently in therapy than they do on the floor or in their room. Simply allowing your therapy provider to capture the section GG data and entering their scores on the MDS without nursing input does not show the full picture of the resident and may not be the “usual performance.” Below is a breakdown of what successful collaboration might look like.
· Nursing captures section GG information on days 1–3 of the resident’s stay, using the AANAC tools.
· Therapy captures section GG information on evaluation using the CARE tool or in therapy.
· Therapy/nursing collaboration should occur on about day 3–4 of the resident’s stay, to discuss section GG items and determine the level to be coded on the Admission assessment.
· Nursing captures section GG information on the last 3 days before the resident’s planned discharge, using the AANAC tools.
· Therapy captures section GG information when gathering data for the discharge summary or on the CARE tool.
· After discharge and prior to completing section GG, therapy and nursing collaborate and determine the level to be coded on the MDS.
With this new data being collected in the not-too-distant future and with a portion of your income being dependent on its capture, now would be a good time to take a look at your section GG data collection process and modify it as needed.
For additional information on changes published in the technical specifications, please see “Section GG Overhaul Coming This Oct. 1 In Conjunction With New QMs
,” published on February 28, 2018; or the webinar Breaking News: Technical Specs on Upcoming Changes to the MDS 10/1/2018
, presented on February 22, 2018.
Note that the section GG information discussed in this article is based on the technical specifications and is subject to additional modification and edits by CMS.
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