Under PDPM, Section GG will now be used to determine functional scores and will impact reimbursement through the case mix index weight. Section GG is going to be used to determine a separate ADL score for Nursing and Therapy, which will impact reimbursement under PDPM, as of 10/1/19. In addition, data for outcome improvement measures is being collected, as of 10/1/18, using Section GG for future use in quality measures that will take effect FY 2020. Therefore, SNF leaders must ensure that the person responsible for coding Section GG on the MDS is astute to the latest best practices.
Section GG Overview Section GG is a collection of data on Self-Care and Mobility items that measure a resident’s “usual performance” during the first three and last three days of a traditional Medicare A stay. This is captured on the 5-Day PPS assessment and End of Medicare Stay assessment.
The 5-Day PPS Assessment must have an ARD set on day 1-8 of the Medicare Part A stay. The lookback period for section GG is days 1-3 starting with the date in A2400B, Start of Most Recent Medicare Stay.
The Part A PPS Discharge Assessment is completed when a resident’s Medicare Part A stay ends. The lookback period for section GG is the last three days of the SNF PPS stay ending on A2400C.
The RAI Manual, Chapter 3 Section GG, is a good place to start to identify coding guidelines. Keep in mind: the Scoring Scale for Section GG: Self-Care and Mobility Items is different than the coding scale for Section G. The Section GG scoring scale under PDPM is: Tips for Scoring "Usual Performance"
The admission functional assessment, when possible, should be conducted prior to treatment interventions in order to determine a true baseline functional status on admission.
CMS anticipates that an interdisciplinary team of qualified clinicians is involved in assessing the resident during the three-day assessment period.
Observe resident’s interactions with others in different locations and circumstances for a comprehensive understanding of resident’s functional status. Do not record resident’s best performance and do not record resident’s worst performance, but rather record resident’s usual performance.
Code based on resident’s actual performance. Do not record the staff’s assessment of resident’s potential capability to perform the activity.
Assess resident’s self-care performance based on direct observation, as well as resident’s self-report and reports from qualified clinicians, care staff, or family documented in resident’s medical record during the three-day assessment period.
SNF providers must assess the current process they are using for collecting and completing Section GG. Under PDPM, Section GG is going to be used to determine a separate ADL score for Nursing and for PT/OT, which will impact reimbursement. Therefore, accuracy of information is essential and it's important to know that reimbursement will be impacted under PDPM according to the following areas of GG:
Tips for Coding Accuracy
When reviewing the medical record, interviewing staff, and observing the resident, be familiar with the definition for each activity.
Residents with cognitive impairments/limitations may need physical and/or verbal assistance when completing an activity. Code based on resident’s need for assistance to perform activity safely.
If resident does not attempt activity and a helper does not complete activity for resident during the assessment period, code the reason activity was not attempted. For example:
code 07 if resident refused to attempt activity
code 09 if activity is not applicable for resident (activity did not occur at the time of the assessment and prior to the current illness, injury, or exacerbation)
code 10 if resident was not able to attempt activity due to environmental limitations
code 88 if resident was not able to attempt activity due to medical condition or safety concerns.
Activities may be completed with or without assistive device(s). Use of assistive device(s) to complete an activity should not affect coding of the activity.
If two or more helpers are required to assist resident to complete activity, code 01, Dependent.
To clarify understanding of resident’s performance of activity, ask probing questions to care staff about resident, beginning with the general and proceeding to the more specific.
Documentation in the medical record is used to support assessment coding of Section GG. Data entered should be consistent with the clinical assessment documentation in the resident’s medical record.
What SNF Leadership Should Do Now To ensure your SNF is precise in completing section GG, ask yourself the following questions:
Do you have a process in place to determine a resident’s “usual performance”?
What sources of information are you using to collect data regarding a resident’s level of functioning to ensure GG is complete?
Is the person currently coding GG knowledgeable in the items that will be used to calculate the two function scores (for nursing and PT/OT)?
Are you using the same amount of effort to collect the initial and discharge GG status?
Take Your PDPM & MDS Knowledge to the Next Level
To learn more about MDS Section GG changes that are coming under PDPM, click below to download the MDS info sheet.
SNF Administrators and MDS leaders can learn more about where Section GG is headed and what leadership should do now to be successful.