Welcome back to the Section GG training. This is segment four, the final
segment of our training.
The ability to safely come to a standing position from sitting in a
chair or on the side of the bed is captured in GG0170D. Sit to stand.
Note that this activity of coming to a standing position includes the
resident standing up from a chair or from the side of the bed so when
determining the resident's usual performance, be sure to consider both
of these. How would you code GG0170D for Mr. M who has osteoarthritis
and is recovering from sepsis? Mr. M transitions from a sitting to a
standing position with the steadying (touching) assistance of the
nurse's hand on Mr. M's trunk. Because the nurse only provides Mr. M
with touching assistance, GG0170D. Sit to stand would be coded 04
indicating supervision or touching assistance. Here is an example of a
conversation between a nurse assessor and the CNA. The nurse uses
probing questions in order to determine the correct coding of GG0170D.
The nurse asks the CNA to please describe how Mrs. L usually moves from
sitting on the side of the bed or chair to a standing position. The
nurse then clarifies the information she is interested in when she goes
on to ask once she is sitting, how does she get to a standing position?
The CNA relays that the resident needs help sitting up and then
standing.
Then, the nurse asks for additional information when she states that
she'd like to know how much help the resident needs for safely rising up
from sitting in a chair or sitting on the bed to get to a standing
position. The CNA then informs the nurse that Mrs. L needs two people to
assist her to stand up from sitting on the side of the bed or when she
is sitting in a chair.
How would you code GG0170D for Mrs. L? GG0170D. Sit to stand would be
coded 01, Dependent because Mrs. L requires the assistance of two
helpers to complete the activity. Even though Mrs. L participates in the
activity, dependent is the correct coding because two helpers are
needed. GG0170E Chair/bed-to-chair transfer captures the resident's
ability to safely transfer to and from a bed to a chair (or wheelchair).
Consider this example regarding Mr. F whose medical conditions include
morbid obesity, diabetes mellitus, and sepsis, and he recently underwent
bilateral above-the-knee amputations. He requires full assistance with
transfers from the bed to the wheelchair using a lift device. Two CNAs
are required for safety when using the device to transfer Mr. F from the
bed to a wheelchair. Mr. F is unable to assist in the transfer from his
bed to the wheelchair. How would you code GG0170E? Two helpers completed
all the effort for the activity of chair/bed-to-chair transfer for Mr. F
therefore GG0170E. Chair/bed-to-chair transfer would be coded 01,
Dependent. Remember, if two or more helpers are required to assist the
resident to complete an activity, code as 01, Dependent. Our next
scenario involves Ms. P who has metastatic bone cancer that has severely
affected her ability to use her lower and upper extremities during daily
activities. Ms. P is motivated to assist with her transfers from the
side of her bed to the wheelchair. She pushes herself up from the bed to
begin the transfer while the therapist provides trunk support. Once
standing, Ms. P shuffles her feet, turns, and slowly sits down into the
wheelchair with the therapist providing trunk support. Overall, the
therapist provides less than half of the effort. How would you code
GG0170E? The helper (the therapist) provided less than half of the
effort for Ms. P to complete the activity of chair/bed-to-chair
transfer. The correct coding of GG0170E. Chair/bed-to-chair transfer is
03, Partial/moderate assistance. GG0170F. Toilet transfer captures the
resident's ability to safely get on and off a toilet or commode. How
would you code GG0170F in this example for Mrs. Y? She is anxious about
getting up to use the bathroom. She asks the CNA to stay with her in the
bathroom as she gets on and off the toilet. The CNA stays with her, as
requested, and provides verbal encouragement and instructions (cues) to
Mrs. Y. Because the helper provides supervision and verbal cues as Mrs.
Y transfers onto and off the toilet, the correct coding of GG0170F.
Toilet transfer would be coded 04, Supervision or touching assistance.
Mr. H is described in our next example. He has paraplegia incomplete,
pneumonia, and a chronic respiratory condition. Mr. H prefers to use the
bedside commode when moving his bowels. Due to his severe weakness,
history of falls, and dependent transfer status, two CNAs assist during
the toilet transfer. How would you code GG0170F for Mr. H? Mr. H
required the assistance of two or more helpers for the resident to
complete the toilet transfer therefore GG0170F would be coded 01,
Dependent. GG0170H1 asks Does the resident walk? If the resident does
not walk and a walking goal is not clinically indicated, the assessor
will code 0 and will then Skip to GG0170Q1, Does the resident use a
wheelchair/scooter? If the resident does not walk but a walking goal is
clinically indicated, the assessor will code 1 and then code the
resident's discharge goal(s) for items GG0170J and/or GG0170K. If the
resident does walk, the assessor will code 2 indicating "Yes" and then
continue to GG0170J, Walk 50 feet with two turns. Let's look at this
example for Mr. Z. He does not currently walk, however based on the
team's assessment of the resident and input from Mr. Z, it has been
determined that a walking goal is indicated. How would you code
GG0170H1? Mr. Z does not currently walk, so no admission performance
code is entered for the walking items. GG0170H1. Does the resident walk?
would be coded 1, No, but a walking goal is clinically indicated.
Because a walking goal is clinically indicated, walking goals may be
coded for items GG0170I. Walk 10 feet; GG0170J. Walk 50 feet with two
turns; and GG0170K. Walk 150 feet. How would you code this next scenario
for GG0170H1 involving Ms. Y? She currently walks with great difficulty
due to her progressive neurological disease. It is not expected that she
will continue to walk. Ms. Y currently walks and admission performance
codes are entered for each walking item. GG0170H1. Does the resident
walk? would be coded 2, Yes, and each walking admission performance item
would then be coded. GG0170H3. Does the resident walk? is completed only
on Discharge, at the End of the resident's SNF PPS Stay. If the assessor
codes 0, indicating No, the instructions are to skip to GG0170Q3, Does
the resident use a wheelchair/scooter? If the assessor codes 2
indicating Yes, the assessor will continue to GG0170J, Walk 50 feet with
two turns. How would you code GG0170H3. Does the Resident Walk? For Ms.
H? At the end of her SNF PPS stay, Ms. H is walking with a quad cane to
all destinations in the facility and safely walks outside in the
courtyard with her walker. Because Ms. H currently walks to all
destinations inside the facility and in the facility courtyard,
GG0170H3. Does the resident walk? would be coded 2, Yes, and each
walking discharge performance item would then be coded. Walk 50 feet
with two turns, item GG0170J, captures, the resident's ability, once
standing, to walk at least 50 feet and make two turns. Consider this
scenario with Mrs. L. She is unable to bear her full weight on her left
leg. As she walks 60 feet down the hall with her crutches and makes two
turns, the CNA supports her trunk and provides less than half the
effort. How would you code GG0170J for Mrs. L? The CNA provides trunk
support as Mrs. L walks more than 50 feet and makes two turns;
therefore, GG0170J. Walk 50 feet with two turns would be coded 03,
Partial/moderate assistance. The resident's ability to walk at least 150
feet in a corridor or similar space once standing is captured in
GG0170K. Walk 150 feet. How would you code GG0170K in this scenario? Mr.
R has endurance limitations due to heart failure and has only walked
about 30 feet during the 3-day assessment period. He has not walked 150
feet or more over the entire look-back period, including with the
physical therapist who has been working with Mr. R. The therapist
speculates that Mr. R could walk this distance in the future with
additional assistance. Because the activity was not attempted, GG0170K.
Walk 150 feet would be coded 88, Activity not attempted due to medical
or safety concerns. GG0170Q1 Does the resident use a wheelchair/scooter?
is completed with Admission at the Start of SNF PPS Stay. If the
resident does not use a wheelchair or scooter, the assessor will code
"0" indicating No and skip to GG0130, Self Care. If the resident uses a
wheelchair or scooter, the assessor will code "1" indicating Yes and
continue to GG0170R, Wheel 50 feet with two turns. GG0170Q3 is completed
at the time of Discharge at the End of SNF PPS Stay - you will notice
this is the same question that I just reviewed in GG0170Q1. The items
are the same on admission and discharge, but the item numbers themselves
are different. With a Yes response to this item, the assessor will again
continue to GG0170R, Wheel 50 feet with two turns but with a No
response, the assessor will skip to H0100, Appliances. In GG0170R. Wheel
50 feet with two turns, the assessor will code the resident's usual
performance, once seated in their wheelchair or scooter, wheeling at
least 50 feet and making two turns. How would you code GG0170R for Ms. R
based on this scenario? Once seated in the manual wheelchair, Ms. R
wheels about 10 feet then asks the therapist to push the wheelchair an
additional 40 feet into her room and her bathroom. GG0170R. Wheel 50
feet with two turns would be coded 02, Substantial/maximal assistance
because the therapist provides more than half the effort. In GG0170RR1,
the assessor will indicate the type of wheelchair or scooter used by the
resident to wheel 50 feet with two turns (as was coded in GG0170R). For
our example with Ms. R, GG0170RR1 would be coded 1 to indicate she has a
manual wheelchair. Code 2 indicates a motorized device. This item is
done with Admission to reflect the device used by the resident at the
Start of their SNF PPS Stay. GG0170RR3 is an identical item that is
completed on Discharge to reflect the device used at the end of SNF PPS
Stay. In GG0170S. Wheel 150 feet, the assessor documents the resident's
ability, once seated in wheelchair/scooter, to wheel at least 150 feet
in a corridor or similar space. Consider how you would code GG0170S
based on this scenario. Mr. G always uses a motorized scooter to
mobilize himself down the hallway and the therapist provides cues due to
safety issues (to avoid running into the walls). The therapist provides
verbal cues for Mr. G to safely complete the activity. Therefore,
GG0170S. Wheel 150 feet would be coded 04, Supervision or touching
assistance. In GG0170SS1, the assessor will indicate the type of
wheelchair or scooter used by the resident to wheel 150 feet (as was
coded in GG0170S) by coding 1 to indicate it is a manual device or 2 to
indicate it is a motorized device. This item is done at the time of
Admission to reflect the device used by the resident at the Start of the
SNF PPS Stay. GG0170SS3 is the same item as GG0170SS1 that was just
discussed, however, on the Discharge the item number is different, and
is completed on Discharge to reflect the device used at the end of SNF
PPS Stay. On the admission (at the start of the resident's PPS stay),
the discharge goals are captured in GG0170. Mobility. Instructions for
coding Discharge Goals for the mobility items (GG0170) are the same as
those for coding Discharge Goals for the self-care items (GG0130). To
summarize, the items in Section GG are used to used to calculate the SNF
QRP Function quality measure. During a Medicare Part A SNF stay,
residents may have self-care limitations on admission. In addition,
residents may be at risk of further functional decline during their stay
in the SNF. Section GG assesses the need for assistance with, and
establishes goals for, self-care and mobility activities. I want to
thank you for participating in this Section GG training and for all that
you do to care for individuals in our country's Skilled Nursing
Facilities.