MDS Alert

Find out what the revised Section A for discharges looks like.

Big changes are taking place in the MDS world, and the addition of a brand-new MDS section is about to add onto your workload. But don’t despair just yet — you’ll notice that this new section looks a lot like Section G — Functional Status.

On July 30, the Centers for Medicare & Medicaid Services (CMS) posted the new Section GG — Functional Abilities and Goals and a revised version of Section A — Identification Information. The Section A revision applies to a new PPS Part A discharge item set. You must begin using these new sections effective Oct. 1, 2016.

Learn Definitions for Functional Self-Care Items

In the new Section GG, the following functional status items are included for self-care (GG0130 — Self-Care):

• GG0130A — 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.

• GG0130B — 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.]

• GG0130C — 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.

Mobility Sub-Items May Remind You of ADLs

If Item GG0130 isn’t already reminding you of your functional status and Activities of Daily Living (ADL) assistance coding in Section G, Item (GG0170 — Mobility) will leave no shadow of a doubt in your mind. The following functional status items are included in Section GG for mobility:

• GG0170B — Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.

• GG0170C — 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.

• GG0170D — Sit to stand: The ability to safely come to a standing position from sitting in a chair or on the side of the bed.

• GG0170E — Chair/bed-to-chair transfer: The ability to safely transfer to and from a bed to a chair (or wheelchair).

• GG0170F — Toilet transfer: The ability to safely get on and off a toilet or commode.

• GG0170H1 (Admission)/GG0170H3 (Discharge) — Does the resident walk?

o 0. No, and walking goal is not clinically indicated → Skip to GG0170Q1, Does the resident use a wheelchair/scooter?

o 1. No, and walking goal is clinically indicated → Code the resident’s discharge goal(s) for items GG0170J and GG0170K

o 2. Yes → Continue to GG0170J, Walk 50 feet with
two turns

• GG0170J — Walk 50 feet with two turns: Once standing, the ability to walk at least 50 feet and make two turns.

• GG0170K — Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space.

Note: Keep in mind that Items GG0170J and GG0170K are for residents who are walking. If you’re completing this section for residents who use a wheelchair, complete Items GG0170R and GG0170S below.

• GG0170Q1 (Admission)/GG0170Q3 (Discharge) — Does the resident use a wheelchair/scooter?

o 0. No → Skip to GG0130, Self-Care (Discharge)

o 1. Yes → Continue to GG0170R, Wheel 50 feet with two turns.

• GG0170R — Wheel 50 feet with two turns: Once seated in wheelchair/scooter, can wheel at least 50 feet and make two turns.

o GG0170RR1 (Admission)/GG0170RR3 (Discharge) — Indicate the type of wheelchair/scooter used.

1. Manual

2. Motorized

• GG0170S — Wheel 150 feet: Once seated in wheelchair/scooter, can wheel at least 150 feet in a corridor or similar space.

o GG0170SS1 (Admission)/GG0170SS1 (Discharge) — Indicate the type of wheelchair/scooter used.

1. Manual

2. Motorized

Use These Coding Conventions for GG0130 & GG0170

For the self-care and the mobility Admission assessments, the look-back period is Days 1 through 3 of the SNF PPS stay beginning with A2400B — Start date of most recent Medicare stay. You should complete this item only if you coded A0310B — PPS Assessment as 01 — 5-day scheduled assessment.

For each of the self-care and mobility sub-items in GG0130, you must code the resident’s usual performance at admission for each activity in Column 1 (Admission Performance), and then code the resident’s discharge goals for each activity in Column 2 (Discharge Goal). You can choose from the following six-point scale for the performance level:

• 06 — Independent — Resident completes the activity by him/herself with no assistance from a helper.

• 05 — Setup or clean-up assistance — Helper SETS UP or CLEANS UP; resident completes activity. Helper assists only prior to or following the activity.

• 04 — Supervision or touching assistance — Helper provides VERBAL CUES or TOUCHING/STEADYING assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.

• 03 — Partial/moderate assistance — Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.

• 02 — Substantial/maximal assistance — Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.

• 01 — Dependent — Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or, the assistance of two or more helpers is required for the resident to complete the activity.

Additionally, you may code in Column 1 that the resident did not attempt the activity, using the code for the reason why the activity was not attempted:

• 07 — Resident refused.

• 09 — Not applicable.

• 88 — Not attempted due to medical condition or safety concerns.

Mistake: But don’t try to use these “not attempted” codes in Column 2 for the discharge goal. You may use only the options in the six-point scale for Column 2 in the admission assessments.

What’s different: Also, keep in mind that the six-point scale for coding Section GG is different than the coding you use for functional status in Section G of the MDS. Specifically, you’ll notice that the definitions in the six-point scale are different in the new Section GG than what you’re accustomed to in Section G.

How Discharge Versions are Different from Admission

The same six-point scale and three “not attempted” coding choices appear on the self-care and mobility assessments for Discharge. You will code the resident’s usual performance at the end of the SNF PPS stay for each activity.

For the Section GG discharge assessment, your look-back period is the last three days of the SNF PPS stay ending on A2400C — End date of most recent Medicare stay. Also, you should complete the Section GG discharge only if:

• You coded A0310H — Is this a SNF PPS Part A Discharge (End of Stay) Assessment? As 1 — Yes; AND

• You did not code A0310G — Type of discharge as 2 — Unplanned; AND

• A2400C — End date of most recent Medicare stay minus A2400B — Start date of most recent Medicare stay is greater than two (2) days; AND

• You did not code A2100 — Discharge Status as 03 — Acute hospital.

What the Part A Discharge Item Set Includes/Excludes

In addition to the new Section GG items, CMS also released a new “Nursing Home and Swing Bed PPS Part A Discharge (End of Stay) (NPE/SPE) Item Set” document. The document includes all of Section A, minus a few items that aren’t relevant to discharge like Preadmission Screening and Resident Review (PASRR) and conditions related to intellectual/developmental disability status (Items A1500, A1510, and A1550).

The discharge item set also contains the new Section GG self-care and mobility discharge item sets, as well as the falls items J1800 and J1900, and the pressure ulcer items M0210, M0300 and M0800. Finally, the document includes Section X — Correction Request and Section Z — Assessment Administration.

Link: You can download the PPS Part A discharge item set at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Part-A-PPS-d-c.pdf.