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Eli's Rehab Report

Why Functional Training Is Taking On New Dimensions

Section GG designed to give the IMPACT Act reality.

All SNF coders and billers need to sit up and take notice of Section GG of the new MDS 3.0, which comes into effect on October 1.

“There is much chatter about who will be completing this section and many believe that it should be therapy,” says Elisa Bovee, Sr. Vice President of Operations, Harmony Healthcare International in Topfield, MA.

The big problem is that Section GG is similar to Section G (Functional Status), yet different in key ways. For instance, the two sections cover the same activities but the scoring scale for Section GG is opposite to Section G.

“The therapy needs and Section GG are exclusive of one another. There may not be a correlation as Section GG is the patient’s usual performance and therapy reports the patient’s best or improving abilities. The evaluation for therapy should contain the goal areas indicated in Section GG,” Bovee advises.

Background: The IMPACT Act of 2014 mandated that the Centers for Medicare & Medicaid Services (CMS) standardize patient assessment and quality measures across post-acute care settings, according to a Feb. 15 blog posting by Colleen Gouldrick of Harmony Healthcare International. As part of this initiative, CMS developed the Continuity Assessment Records and Evaluation (CARE) Item Set, which measures Medicare beneficiaries’ health and functional status at the time of acute discharge, as well as changes in severity and other outcomes for Medicare PAC patients.

Effective Oct. 1, 2016, skilled nursing facilities (SNFs) must begin using the new MDS 3.0 Sections A and GG to submit both functional and quality measure data in the form of patient assessments, Gouldrick noted.

Get Ready for New Section GG

The brand new Section GG — Functional Abilities and Goals contains two major items:

  • GG0130 — Self-Care; and
  • GG0170 — Mobility.

What to expect: In Item GG0130, you will code the resident’s functional status regarding self-care items, including eating, oral hygiene, and toileting hygiene, according to HHI. Item GG0170 captures the resident’s functional status regarding mobility, including sitting to lying and lying to sitting on the side of the bed, sitting to standing, various walking skills, and chair, bed and toileting transfers.

Initially, you will code these items on admission to Medicare Part A with an assessment period of one to three days after the start of Medicare dates coded in Item A2400 — Medicare Stay, HHI explains. You’ll complete Section GG with the five-day PPS assessment and the Discharge from Medicare Part A assessments only, and not with any other assessment types.

When You Need to Complete Section GG

The new Item GG0130 — Self-Care appears on admission to PPS Part A and again at discharge, according to the Kansas Department for Aging and Disability Services (KDADS). This includes an assessment of the resident’s admission performance and discharge goals for eating, oral hygiene, and toileting. At discharge from the PPS Part A stay, you will evaluate the discharge performance again and score Item GG0130.

Also, you will capture the new Item GG0170 — Mobility on admission to PPS Part A and again at discharge, KDADS explained. This item includes an assessment of the resident’s admission performance and discharge goal for how the resident moves from sitting to lying and from lying to sitting on the side of the bed, from sitting to standing, as well as in chair, bed, and toilet transfers. The item also measures a variety of walking skills.

For more on SNF coding, compliance and reimbursement issues, please see MDS Alert.