MDS Alert

Recognize how to judge more/less than half the effort.

Learning to code the new Section GG — Functional Abilities and Goals correctly won’t be the easiest task, but you can make your job a little simpler by studying coding examples that highlight the most common scenarios you’ll likely encounter.

Here are a few coding scenarios from the RAI Manual update that are specific to coding item GG0170 — Mobility:

Scenario #1: Mrs. Smith requires assistance from a nurse to transfer from sitting at the edge of the bed to lying flat on the bed due to paralysis on her right side. The nurse lifts and positions Mrs. Smith’s right leg. Mrs. Smith then uses her arm to position her upper body. Overall, Mrs. Smith performs more than half of the effort.

How to code: Code GG0170B — Sit to lying as 03 — Partial/moderate assistance. Although the nurse lifts Mrs. Smith’s right leg and helps her position it as she moves from a seated to a lying position, Mrs. Smith does more than half of the effort.

Scenario #2: Mr. Jones is being treated for sepsis and has multiple infected wounds on his lower extremities. He needs full assistance from the CNA to move from a lying position to sitting on the side of the bed because he usually has pain in his lower extremities upon movement.

How to code: Code GG0170C — Lying to sitting on side of bed as 01 — Dependent, because the CNA fully completed the activity of lying to sitting on the side of the bed for Mr. Jones.

Scenario #3: Mr. Brown has osteoarthritis and is recovering from sepsis. He transitions from a sitting to a standing position with the nurse’s hand on his trunk.

How to code: Code GG0170D — Sit to stand as 04 — Supervision or touching assistance, because the nurse provides steadying (touching) assistance only.

Scenario #4: Mrs. Johnson had her left lower leg amputated because of gangrene associated with her diabetes mellitus and now has reduced sensation and strength in her right leg. She has not yet received her below-the-knee prosthesis. Mrs. Johnson uses a transfer board for chair/bed-to-chair transfers.

The physical therapist places the transfer board under Mrs. Johnson’s buttock, and then Mrs. Johnson attempts to scoot from the bed onto the transfer board. She has reduced sensation in her hands and limited upper body strength, so the therapist assists her in side scooting by lifting her trunk in a rocking motion as Mrs. Johnson scoots across the transfer board and into the wheelchair. Overall, the therapist provides more than half of the effort.

How to code: Code GG0170E — Chair/bed-to-chair transfer as 02 — Substantial/maximal assistance, because the physical therapist provided more than half of the effort for Mrs. Johnson to complete the transfer.

Scenario #5: The CNA moves the wheelchair footrests up so that Mr. Green can transfer from the wheelchair onto the toilet by himself safely. The CNA is not present during the transfer itself, because supervision is not required. Once Mr. Green completes the transfer from the toilet back to the wheelchair, he flips the footrests back down himself.

How to code: Code GG0170F — Toilet transfer as 05 — Setup or clean-up assistance, because the CNA provides setup assistance (moving the footrest out of the way) before Mr. Green can transfer safely onto the toilet.

Scenario #6: Mr. Ryan has endurance limitations due to heart failure and has walked only about 30 feet during the three-day assessment period. He has not walked 150 feet or more during the assessment period, including with the physical therapist who has been working with him. The therapist speculates that Mr. Ryan could walk this distance in the future with additional assistance.

How to code: Code GG0170K — Walk 150 feet as 88 — Activity not attempted due to medical or safety concerns, because the activity was not attempted.