By Lori O’Hara, CCC-SLP, Skilled Reimbursement Resource
Welcome to Part 1 of a two-part series on mastering Section GG for PDPM. This article will focus on how to score items for Section GG. In Part 2, we’ll talk about best practices for documenting and coding section GG.
Section GG in the MDS is all about functional abilities. It details how a patient used to perform these tasks prior to illness, how they perform them at the time of the assessment, and how they hope to perform them in the future. Section GG data is used for both PDPM calculations and Quality Reporting Program data. While the focus here will be on PDPM, don’t forget that this data affects you in lots of other ways!
The two Section GG areas that impact PDPM are Self Care (Section GG0130) and Mobility (Section GG0170). These two areas impact the final category for the Nursing and Physical and Occupational Therapy case mix categories.
Here are the functional abilities that are part of the PDPM calculations.
For the Nursing Category:
● Eating: The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is presented on a table/tray. Includes modified food consistency.
● Toilet hygiene: The ability to maintain perineal hygiene and perineal cleansing, adjust clothes before and after using the toilet, commode, bedpan, or urinal. If managing an ostomy, include wiping the opening but not managing equipment.
● Bed mobility, which averages the scores for:
o Sit to lying: The ability to move from sitting on the side of the bed to lying flat on the bed.
o Lying to sitting on the side of the 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.
● Transfer tasks, which averages the scores for:
o Sit to stand: The ability to safely come to a standing position from sitting in a chair or on the side of the bed.
o Chair/Chair-to-bed transfer: The ability to safely transfer to and from a bed to a chair (or wheelchair). Refer to the RAI manual for mechanical lift transfers.
o Toilet transfer: The ability to safely get on and off of a toilet (with or without a raised toilet seat) or bedside commode.
For Therapy, add:
● 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.
● Mobility, which averages the scores for:
o Walk 50 feet with two turns: Once standing, the ability to walk at least 50 feet and make two turns.
o Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space.
Each functional task is scored for how independently the resident can complete it. This is the scoring scale:
And CMS has provided a decision tree to help with dialing in what score to use:
Special considerations:
● For Section GG, code Dependent whenever two or more people are helping, even when the patient can perform a bit of the activity themselves.
● Only code 07, 09, 10, or 88 if those circumstances occurred every single time. If the resident performed the activity even once, then use that data to score the ability for the MDS.
● An activity can still be scored Independent when the patient uses an assistive device when no assistance or cueing is needed.
● When coding Eating, administration of tube feedings is not considered. If the patient does not eat at all by mouth and this is a new condition, code 88 (not attempted due to medical or safety concern). If the patient needed non-oral nutrition prior to the current illness, code 09 (not applicable, as the resident did not perform this activity prior to the current illness).
The RAI Manual provides many tips and answers for special circumstances, so refer to it whenever something unusual arises.
Here are a few sample circumstances and how they should be coded:
● Resident S has multiple sclerosis, affecting their endurance and strength. Resident S prefers to feed themself as much as they are capable. During all meals, after eating three-fourths of the meal by themself, Resident S usually becomes extremely fatigued and requests assistance from the certified nursing assistant to feed them the remainder of the meal.
o This performance would be scored 03, Partial/Moderate Assistance since the CNA provides less than half the effort for the resident to complete the activity of eating.
• The certified nursing assistant provides steadying (touching) assistance as Resident Z transfers onto the toilet and lowers their underwear. After voiding, Resident Z cleanses themself. They then stand up as the helper steadies them, and Resident Z pulls up their underwear as the helper steadies them to ensure Resident Z does not lose their balance.
• This performance would be scored 04, Supervision or Touching Assistance. The helper provides steadying assistance as the resident transfers onto and off the toilet. Assistance with managing clothing and cleansing is coded under item GG0130C, toileting hygiene, and is not considered when rating the toilet transfer item.
Be sure to read next month’s newsletter, when we’ll discuss best practices for documenting and coding Section GG items into the MDS.
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