GG0170: Mobility (3-day assessment period) Admission

 

 

 

 

 

 

 

 

 

GG0170: Mobility (3-day assessment period) Discharge

 

 

 

 

 

 

 

 

 

GG0170: Mobility (OBRA/Interim)

 

 

 

 

 

 

 

 

 

 

 

 

GG0170: Mobility (cont.)

Item Rationale

Residents may have mobility limitations on admission. In addition, residents may be at risk of further functional decline during their stay in the facility. Please review the item rationale for GG0130, Self-Care, for additional information about the importance of assessing ADLs, including information about health-related quality of life and planning for care.

 

Steps for Assessment

 

DEFINITION USUAL PERFORMANCE A resident’s functional status can be impacted by the environment or situations encountered at the facility. Observing the resident’s interactions with others in different locations and circumstances is important for a comprehensive understanding of the resident’s functional status. If the resident’s functional status varies, record the resident’s usual ability to perform each activity. Do not record the resident’s best performance and do not record the resident’s worst performance, but rather record the resident’s usual performance.

Assess the resident’s mobility performance based on direct observation, incorporating resident self-reports and reports from qualified clinicians, care staff, or family documented in the resident’s medical record during the assessment period. CMS anticipates that a multidisciplinary team of qualified clinicians is involved in assessing the resident during the assessment period.

For residents in a Medicare Part A stay, the admission assessment period is the first 3 days of the Part A stay starting with the date in A2400B, the Start of Most Recent Medicare Stay. The admission assessment period for residents who are not in a Medicare Part A stay is the first 3 days of their stay starting with the date in A1600, Entry Date.

Note: If A0310B = 01 and A0310A = 01 – 06 indicating a 5-day PPS assessment combined with an OBRA assessment, the assessment period is the first 3 days of the stay beginning on A2400B and both columns are required. In these scenarios, do not complete Column 5. OBRA/Interim Performance.

For residents in a Medicare Part A stay, the assessment period for the Interim Payment Assessment (A0310B = 08)

is the last 3 days (i.e., the ARD plus 2 previous calendar days).

For residents in a Medicare Part A stay, the discharge assessment period is the End Date of Most Recent Medicare Stay (A2400C) plus 2 previous calendar days. For all other Discharge assessments, the assessment period is A2000, Discharge Date plus 2 previous calendar days.

When completing an OBRA-required assessment other than an Admission assessment (i.e., A0310A = 02 – 06), the assessment period is the ARD plus 2 previous calendar days.

Residents should be allowed to perform activities as independently as possible, as long as they are safe.

 

 

For the purposes of completing Section GG, a “helper” is defined as facility staff who are direct employees and facility-contracted employees (e.g., rehabilitation staff, nursing agency staff). Thus, does not include individuals hired, compensated or not, by individuals outside of the facility’s management and administration, such as hospice staff, nursing/certified nursing assistant students, etc. Therefore, when helper assistance is required because a resident’s performance is unsafe or of poor quality, only consider facility staff when scoring according to amount of assistance provided.

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.

For residents in a Medicare Part A stay, the admission functional assessment, when possible, should be conducted prior to the resident benefitting from treatment interventions in order to reflect the resident’s true admission baseline functional status. If treatment has started, for example, on the day of admission, a baseline functional status assessment can still be conducted. Treatment should not be withheld in order to conduct the functional assessment.

Refer to facility, Federal, and State policies and procedures to determine which SNF staff members may complete an assessment. Resident assessments are to be done in compliance with facility, Federal, and State requirements.

 

Coding Instructions

When coding the resident’s usual performance and the resident’s discharge goal(s), use the six-point scale, or one of the four “activity was not attempted” codes (07, 09, 10, and 88), to specify the reason why an activity was not attempted.

Code 06, Independent: if the resident completes the activity by themself with no assistance from a helper.

Code 05, Setup or clean-up assistance: if the helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity, but not during the activity. For example, the resident requires placement of a bed rail to facilitate rolling, or requires setup of a leg lifter or other assistive devices.

Code 04, Supervision or touching assistance: if the helper provides verbal cues or touching/steadying/contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. For example, the resident requires verbal cueing, coaxing, or general supervision for safety to complete the activity; or resident may require only incidental help such as contact guard or steadying assistance during the activity.

Code 03, Partial/moderate assistance: if the helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. For example, the resident requires assistance such as partial weight-bearing assistance, but HELPER does LESS THAN HALF the effort.

 

 

Code 02, Substantial/maximal assistance: if the helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.

Code 01, Dependent: if the 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.

Code 07, Resident refused: if the resident refused to complete the activity.

Code 09, Not applicable: if the activity was not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury.

Code 10, Not attempted due to environmental limitations: if the resident did not attempt this activity due to environmental limitations. Examples include lack of equipment and weather constraints.

Code 88, Not attempted due to medical condition or safety concerns: if the activity was not attempted due to medical condition or safety concerns.

For additional information on coding the resident’s performance on the assessment instrument, refer to the Decision Tree on page GG-18.

 

Coding Tips

Admission: The 5-Day PPS assessment (A0310B = 01) is the first Medicare-required assessment to be completed when the resident is admitted for a SNF Part A stay. Additionally, an OBRA Admission assessment (A0310A = 1) is required for a new resident and, under some circumstances, a returning resident and must be completed by the end of day 14. Please refer to Section 2.6 of this Manual for additional information about the OBRA Admission assessment.

For the 5-Day PPS assessment, code the resident’s functional status based on a clinical assessment of the resident’s performance that occurs soon after the resident’s admission. This functional assessment must be completed within the first three days (3 calendar days) of the Medicare Part A stay, starting with the date in A2400B, Start of Most Recent Medicare Stay, and the following two days, ending at 11:59 PM on day 3. The admission function scores are to reflect the resident’s admission baseline status and are to be based on an assessment. The scores should reflect the resident’s status prior to any benefit from interventions. The assessment should occur prior to the resident benefitting from treatment interventions in order to determine the resident’s true admission baseline status. Even if treatment started on the day of admission, a baseline functional status assessment can still be conducted. Treatment should not be withheld in order to conduct the functional assessment.

For an OBRA Admission assessment, code the resident’s usual performance during first 3 days of their stay starting with the date in A1600, Entry Date.

 

 

OBRA/Interim:

The Interim Payment Assessment (IPA) (A0310B = 08) is an optional assessment that may be completed by providers in order to report a change in the resident’s PDPM classification.

OBRA assessments (A0310A = 01 – 06) are required for residents in Medicare- certified, Medicaid-certified, or dually certified nursing homes and are outlined in Chapter 2 of this Manual.

For Section GG on the IPA or an OBRA assessment, providers will use the same 6- point scale and activity not attempted codes to assess the resident’s usual functional status during the 3-day assessment period.

The ARD for the IPA is determined by the provider, and the assessment period is the last 3 days (i.e., the ARD plus 2 previous calendar days). It is important to note that the IPA changes payment beginning on the ARD and continues until the end of the Medicare Part A stay or until another IPA is completed. The IPA does not affect the variable per diem schedule.

For Section GG on OBRA assessments other than the Admission assessment (i.e., A0310A = 02 – 06), the assessment period is the last 3 days (i.e., the ARD plus 2 previous calendar days).

Discharge: The Part A PPS Discharge assessment is required to be completed as a standalone assessment when the resident’s Medicare Part A stay ends (as documented in A2400C, End of Most Recent Medicare Stay) and the resident remains in the facility. The Part A PPS Discharge assessment must be combined with an OBRA Discharge if the Medicare Part A stay ends on the day of, or one day before, the resident’s Discharge Date (A2000). An OBRA Discharge assessment is required when the resident is discharged from the facility. Please see Chapter 2 and Section A of the RAI Manual for additional details regarding Discharge assessments.

For the Discharge assessment, (i.e., standalone Part A PPS or combined OBRA/Part A PPS), code the resident’s discharge functional status, based on a clinical assessment of the resident’s performance that occurs as close to the time of the resident’s discharge from Medicare Part A as possible. This functional assessment must be completed within the last three calendar days of the resident’s Medicare Part A stay, which includes the day of discharge from Medicare Part A and the two days prior to the day of discharge from Medicare Part A.

On standalone OBRA Discharge assessments (i.e., A0310F = 10 or 11 AND A0310H = 0), code the resident’s usual performance during last 3 days of their stay (i.e., A2000, Discharge Date plus 2 previous calendar days).

 

 

Coding Tips

General Coding Tips

When reviewing the medical record, interviewing staff, and observing the resident, be familiar with the definition for each activity. For example, when assessing GG0170J, Walk 50 feet with two turns, determine the type and amount of assistance required as the resident walks 50 feet and negotiates two turns.

Residents with cognitive impairments/limitations may need physical and/or verbal assistance when completing an activity. Code based on the resident’s need for assistance to perform the activity safely (for example, fall risk due to increased mobility activities).

An activity can be completed independently with or without devices. If the resident has adaptive equipment, retrieves the equipment without assistance, and performs the activity independently using the device, enter code 06, Independent.

If two or more helpers are required to assist the resident to complete the activity, code as 01, Dependent.

To clarify your own understanding and observations about a resident’s performance of an activity, ask probing questions, beginning with the general and proceeding to the more specific. See examples of using probes when talking with staff at the end of this section.

A dash (“-”) indicates “No information.” CMS expects dash use to be a rare occurrence.

Documentation in the medical record is used to support assessment coding of Section GG and should be consistent with the clinical assessment documentation in the resident’s medical record. This assessment can be conducted by appropriate healthcare personnel as defined by facility policy and in accordance with local, State, and Federal regulations.

CMS does not provide an exhaustive list of assistive devices that may be used when coding self-care and mobility activities. Clinical assessments may include any device or equipment that the resident can use to allow them to safely complete the activity as independently as possible.

Do not code self-care and mobility activities with use of a device that is restricted to resident use during therapy sessions (e.g., parallel bars, exoskeleton, or overhead track and harness systems).

 

 

Tips for Coding the Resident’s Usual Performance

When coding the resident’s usual performance, “effort” refers to the type and amount of assistance a helper provides in order for the activity to be completed. The six-point rating scale definitions include the following types of assistance: setup/cleanup, touching assistance, verbal cueing, and lifting assistance.

Do not record the resident’s best performance, and do not record the resident’s worst performance, but rather record the resident’s usual performance during the assessment period.

Code based on the resident’s performance. Do not record the staff’s assessment of the resident’s potential capability to perform the activity.

If the resident performs the activity more than once during the assessment period and the resident’s performance varies, coding in Section GG is based on the resident’s “usual performance,” which is identified as the resident’s usual activity/performance for any of the Self-Care or Mobility activities, not the most independent or dependent performance over the assessment period. A provider may need to use the entire assessment period to obtain the resident’s usual performance.

 

 

Examples and Coding Tips

Note: The following are coding examples and coding tips for mobility items. Some examples describe a single observation of the person completing the activity; other examples describe a summary of several observations of the resident completing an activity across different times of the day and different days.

Coding Tip for GG0170A, Roll left and right

If the resident does not sleep in a bed, clinicians should assess bed mobility activities using the alternative furniture on which the resident sleeps (for example, a recliner).

 

Examples for GG0170A, Roll left and right

Roll left and right: Resident R has a history of skin breakdown. A nurse instructs them to turn onto their right side, providing step-by-step instructions to use the bedrail, bend their left leg, and then roll onto their right side. Resident R attempts to roll with the use of the bedrail, but indicates they cannot perform the task. The nurse then rolls them onto their right side. Next, Resident R is instructed to return to lying on their back, which they successfully complete. Resident R then requires physical assistance from the nurse to roll onto their left side and to return to lying on their back to complete the activity.

Coding: GG0170A would be coded 02, Substantial/maximal assistance.

Rationale: The nurse provides more than half of the effort needed for the resident to complete the activity of rolling left and right. This is because the nurse provides physical assistance to move Resident R’s body weight to turn onto their right side. The nurse provides the same assistance when Resident R turns to their left side and when they return to their back. Resident R is able to return to lying on their back from their right side by themself.

 

Roll left and right: A physical therapist helps Resident K turn onto their right side by instructing them to bend their left leg and roll onto their right side. The physical therapist then instructs them on how to position their limbs to return to lying on their back and then to repeat a similar process for rolling onto their left side and then return to lying on their back. Resident K completes the activity without physical assistance from the physical therapist.

Coding: GG0170A would be coded 04, Supervision or touching assistance. Rationale: The physical therapist provides verbal cues (i.e., instructions) to Resident K as they roll from their back to their right side and return to lying on their back, and then again as they perform the same activities with respect to their left side. The physical therapist does not provide any physical assistance.

 

 

Roll left and right: Resident Z had a stroke that resulted in paralysis on their right side and is recovering from cardiac surgery. They require the assistance of two certified nursing assistants when rolling onto their right side and returning to lying on their back and also when rolling onto their left side and returning to lying on their back.

Coding: GG0170A would be coded 01, Dependent.

Rationale: Two certified nursing assistants are needed to help Resident Z roll onto their

left and right side and back while in bed.

 

Roll left and right: Resident M fell and sustained left shoulder contusions and a fractured left hip and underwent an open reduction internal fixation of the left hip. A physician’s order allows them to roll onto their left hip as tolerated. A certified nursing assistant assists Resident M in rolling onto their right side by instructing them to bend their left leg while rolling to their right side. Resident M needs physical assistance from the certified nursing assistant to initiate their rolling right because of their left arm weakness when grasping the right bedrail to assist in rolling. Resident M returns to lying on their back without assistance and uses their right arm to grasp the left bedrail to slowly roll onto their left hip and then return to lying on their back.

Coding: GG0170A would be coded 03, Partial/moderate assistance.

Rationale: The helper provides less than half the effort needed for the resident to complete the activity of rolling left and right.

 

Examples for GG0170B, Sit to lying

Sit to lying: Resident H requires assistance from a nurse to transfer from sitting at the edge of the bed to lying flat on the bed because of paralysis on their right side. The helper lifts and positions Resident H’s right leg. Resident H uses their arms to position their upper body and lowers themself to a lying position flat on their back.

Coding: GG0170B would be coded 03, Partial/moderate assistance.

Rationale: A helper lifts Resident H’s right leg and helps them position it as they move from a seated to a lying position; the helper performs less than half of the effort.

Sit to lying: Resident F requires assistance from a certified nursing assistant to get from a sitting position to lying flat on the bed because of postsurgical open reduction internal fixation healing fractures of their right hip and left and right wrists. The certified nursing assistant cradles and supports their trunk and right leg to transition Resident F from sitting at the side of the bed to lying flat on the bed. Resident F assists themself a small amount by bending their elbows and left leg while pushing their elbows and left foot into the mattress only to straighten their trunk while transitioning into a lying position.

Coding: GG0170B would be coded 02, Substantial/maximal assistance.

Rationale: The helper provided more than half the effort for the resident to complete the activity of sit to lying.

 

 

Sit to lying: Resident H requires assistance from two certified nursing assistants to transfer from sitting at the edge of the bed to lying flat on the bed due to paralysis on their right side, obesity, and cognitive limitations. One of the certified nursing assistants explains to Resident H each step of the sitting to lying activity. Resident H is then fully assisted to get from sitting to a lying position on the bed. Resident H makes no attempt to assist when asked to perform the incremental steps of the activity.

Coding: GG0170B would be coded 01, Dependent.

Rationale: The assistance of two certified nursing assistants was needed to complete the activity of sit to lying. If two or more helpers are required to assist the resident to complete an activity, code as 01, Dependent.

Sit to lying: Resident F had a stroke about 2 weeks ago and is unable to sequence the necessary movements to complete an activity (apraxia). They can maneuver themself when transitioning from sitting on the side of the bed to lying flat on the bed if the certified nursing assistant provides verbal instructions as to the steps needed to complete this task.

Coding: GG0170B would be coded 04, Supervision or touching assistance. Rationale: A helper provides verbal cues in order for the resident to complete the activity of sit to lying flat on the bed.

Sit to lying: Resident A suffered multiple vertebral fractures due to a fall off a ladder. They require assistance from a therapist to get from a sitting position to lying flat on the bed because of significant pain in their lower back. The therapist supports their trunk and lifts both legs to assist Resident A from sitting at the side of the bed to lying flat on the bed. Resident A assists themself a small amount by raising one leg onto the bed and then bending both knees while transitioning into a lying position.

Coding: GG0170B would be coded 02, Substantial/maximal assistance.

Rationale: The helper provided more than half the effort for the resident to complete the activity of sit to lying.

 

Coding Tips for GG0170C, Lying to sitting on side of bed

The activity includes resident transitions from lying on their back to sitting on the side of the bed without back support. The residents’ ability to perform each of the tasks within this activity and how much support the residents require to complete the tasks within this activity is assessed.

For item GG0170C, Lying to sitting on side of bed, clinical judgment should be used to determine what is considered a “lying” position for a particular resident.

Back support refers to an object or person providing support for the resident’s back.

If the qualified clinician determines that bed mobility cannot be assessed because of the degree to which the head of the bed must be elevated because of a medical condition, then code the activities GG0170A, Roll left and right, GG0170B, Sit to lying, and GG0170C, Lying to sitting on side of bed, as 88, Not attempted due to medical condition or safety concern.

 

 

Examples for GG0170C, Lying to sitting on side of bed

Lying to sitting on side of bed: Resident B pushes up from the bed to get themself from a lying to a seated position. The certified nursing assistant provides steadying (touching) assistance as Resident B scoots themself to the edge of the bed and lowers their feet onto the floor.

Coding: GG0170C would be coded 04, Supervision or touching assistance. Rationale: The helper provides touching assistance as the resident moves from a lying to sitting position.

Lying to sitting on side of bed: Resident B pushes up on the bed to attempt to get themself from a lying to a seated position as the occupational therapist provides much of the lifting assistance necessary for them to sit upright. The occupational therapist provides additional lifting assistance as Resident B scoots themself to the edge of the bed and lowers their feet to the floor.

Coding: GG0170C would be coded 02, Substantial/maximal assistance. Rationale: The helper provides lifting assistance (more than half the effort) as the resident moves from a lying to sitting position.

Lying to sitting on side of bed: Resident P is being treated for sepsis and has multiple infected wounds on their lower extremities. Full assistance from the certified nursing assistant is needed to move Resident P from a lying position to sitting on the side of their bed because they usually have pain in their lower extremities upon movement.

Coding: GG0170C would be coded 01, Dependent.

Rationale: The helper fully completed the activity of lying to sitting on the side of bed for the resident.

Lying to sitting on side of bed: Resident P is recovering from Guillain-Barre Syndrome with residual lower body weakness. The certified nursing assistant steadies Resident P’s trunk as they get to a fully upright sitting position on the bed and lifts each leg toward the edge of the bed. Resident P then scoots toward the edge of the bed and places both feet flat on the floor. Resident P completes most of the effort to get from lying to sitting on the side of the bed.

Coding: GG0170C would be coded 03, Partial/moderate assistance.

Rationale: The helper provided lifting assistance and less than half the effort for the resident to complete the activity of lying to sitting on side of bed.

 

 

Coding Tips for GG0170D, Sit to stand

The activity includes the resident coming to a standing position from any sitting surface.

If a sit-to-stand (stand assist) lift is used and two helpers are needed to assist with the sit-to- stand lift, then code as 01, Dependent.

 

If a full-body mechanical lift is used to assist in transferring a resident for a chair/bed-to- chair transfer, code GG0170D, Sit to stand with the appropriate “activity not attempted” code.

 

Code as 05, Setup or clean-up assistance, if the only help a resident requires to complete the sit-to-stand activity is for a helper to retrieve an assistive device or adaptive equipment, such as a walker or ankle-foot orthosis.

 

Examples for GG0170D, Sit to stand

Sit to stand: Resident M has osteoarthritis and is recovering from sepsis. Resident M transitions from a sitting to a standing position with the steadying (touching) assistance of the nurse’s hand on Resident M’s trunk.

Coding: GG0170D would be coded 04, Supervision or touching assistance.

Rationale: The helper provides touching assistance only.

Sit to stand: Resident L has multiple healing fractures and multiple sclerosis, requiring two certified nursing assistants to assist them to stand up from sitting in a chair.

Coding: GG0170D would be coded 01, Dependent.

Rationale: Resident L requires the assistance of two helpers to complete the activity.

Sit to stand: Resident B has complete tetraplegia and is currently unable to stand when getting out of bed. They transfer from their bed into a wheelchair with assistance. The activity of sit to stand is not attempted due to their medical condition.

Coding: GG0170D would be coded 88, Not attempted due to medical condition or safety concerns.

Rationale: The activity is not attempted due to the resident’s diagnosis of complete tetraplegia.

 

 

Sit to stand: Resident Z has amyotrophic lateral sclerosis with moderate weakness in their lower and upper extremities. Resident Z has prominent foot drop in their left foot, requiring the use of an ankle foot orthosis (AFO) for standing and walking. The certified nursing assistant applies Resident Z’s AFO and places the platform walker in front of them; Resident Z uses the walker to steady themself once standing. The certified nursing assistant provides lifting assistance to get Resident Z to a standing position and must also provide assistance to steady Resident Z’s balance to complete the activity.

Coding: GG0170D would be coded 02, Substantial/maximal assistance. Rationale: The helper provided lifting assistance and more than half of the effort for the resident to complete the activity of sit to stand.

Sit to stand: Resident R has severe rheumatoid arthritis and uses forearm crutches to ambulate. The certified nursing assistant brings Resident R their crutches and helps them to stand at the side of the bed. The certified nursing assistant provides some lifting assistance to get Resident R to a standing position but provides less than half the effort to complete the activity.

Coding: GG0170D would be coded 03, Partial/moderate assistance.

Rationale: The helper provided lifting assistance and less than half the effort for the resident to complete the activity of sit to stand.

 

Coding Tips for GG0170E, Chair/bed-to-chair transfer

Depending on the resident’s abilities, the transfer may be a stand-pivot, squat-pivot, or a slide board transfer.

For item GG0170E, Chair/bed-to-chair transfer:

When assessing the resident moving from the chair/bed to the chair, the assessment begins with the resident sitting at the edge of the bed (or alternative sleeping surface) and ends with the resident sitting in a chair or wheelchair.

When assessing the resident moving from the chair to the bed, the assessment begins with the resident sitting in a chair or wheelchair and ends with the resident returning to sitting at the edge of the bed (or alternative sleeping surface).

The activities of GG0170B, Sit to lying, and GG0170C, Lying to sitting on side of bed, are two separate activities that are not assessed as part of GG0170E.

If a mechanical lift is used to assist in transferring a resident for a chair/bed-to-chair transfer and two helpers are needed to assist with the mechanical lift transfer, then code as 01, Dependent, even if the resident assists with any part of the chair/bed-to-chair transfer.

When possible, the transfer should be assessed in an environmental situation in which taking more than a few steps would not be necessary to complete the transfer.

 

 

Examples for GG0170E, Chair/bed-to-chair transfer

Chair/bed-to-chair transfer: Resident L had a stroke and currently is not able to walk. They use a wheelchair for mobility. When Resident L gets out of bed, the certified nursing assistant moves the wheelchair into the correct position and locks the brakes so that

Resident L can transfer into the wheelchair safely. Resident L had been observed several other times to determine any safety concerns, and it was documented that they transfer safely without the need for supervision. Resident L transfers into the wheelchair by themself (no helper) after the certified nursing assistant leaves the room.

Coding: GG0170E would be coded 05, Setup or clean-up assistance. Rationale: Resident L is not able to walk, so they transfer from their bed to a wheelchair when getting out of bed. The helper provides setup assistance only.

Resident L transfers safely and does not need supervision or physical assistance during the transfer.

Chair/bed-to-chair transfer: Resident C is sitting on the side of the bed. They stand and pivot into the chair as the nurse provides contact guard (touching) assistance. The nurse reports that one time Resident C only required verbal cues for safety, but usually Resident C requires touching assistance.

Coding: GG0170E would be coded 04, Supervision or touching assistance.

Rationale: The helper provides touching assistance during the transfers.

Chair/bed-to-chair transfer: Resident F’s medical conditions include morbid obesity, diabetes mellitus, and sepsis, and they recently underwent bilateral above-the-knee amputations. Resident F requires full assistance with transfers from the bed to the wheelchair using a lift device. Two certified nursing assistants are required for safety when using the device to transfer Resident F from the bed to a wheelchair. Resident F is unable to assist in the transfer from their bed to the wheelchair.

Coding: GG0170E would be coded 01, Dependent.

Rationale: The two helpers completed all the effort for the activity of chair/bed-to-chair transfer. If two or more helpers are required to assist the resident to complete an activity, code as 01, Dependent.

Chair/bed-to-chair transfer: Resident P has metastatic bone cancer, severely affecting their ability to use their lower and upper extremities during daily activities. Resident P is motivated to assist with their transfers from the side of their bed to the wheelchair.

Resident P pushes themself up from the bed to begin the transfer while the therapist provides limited trunk support with weight-bearing assistance. Once standing, Resident P shuffles their feet, turns, and slowly sits down into the wheelchair with the therapist providing trunk support with weight-bearing assistance.

Coding: GG0170E would be coded 03, Partial/moderate assistance.

Rationale: The helper provided less than half of the effort for the resident to complete the activity of chair/bed-to-chair transfer.

 

 

Chair/bed-to-chair transfer: Resident U had their left lower leg amputated due to gangrene associated with their diabetes mellitus and they have reduced sensation and strength in their right leg. They have not yet received their below-the-knee prosthesis. Resident U uses a transfer board for chair/bed-to-chair transfers. The therapist places the transfer board under their buttock. Resident U then attempts to scoot from the bed onto the transfer board. Resident U has reduced sensation in their hands and limited upper body strength, but assists with the transfer. The physical therapist assists them in side scooting by lifting their buttocks/trunk in a rocking motion across the transfer board and into the wheelchair.

Coding: GG0170E would be coded 02, Substantial/maximal assistance.

Rationale: The helper provided more than half of the effort for the resident to complete the activity of chair/bed-to-chair transfer.

Coding Tips for GG0170F, Toilet transfer

Toilet transfer includes the resident’s ability to get on and off a toilet (with or without a raised toilet seat) or bedside commode.

Toileting hygiene, clothing management, and transferring on and off a bedpan are not considered part of the Toilet transfer activity.

Code as 05, Setup or clean-up assistance, if the resident requires a helper to position/set up the bedside commode before and/or after the resident’s bed-to-commode transfers (place at an accessible angle/location next to the bed) and the resident does not require helper assistance during Toilet transfers.

 

Examples for GG0170F, Toilet transfer

Toilet transfer: The certified nursing assistant moves the wheelchair footrests up so that Resident T can transfer from the wheelchair onto the toilet by themself safely. The certified nursing assistant is not present during the transfer, because supervision is not required. Once Resident T completes the transfer from the toilet back to the wheelchair, they flip the footrests back down themself.

Coding: GG0170F would be coded 05, Setup or clean-up assistance.

Rationale: The helper provides setup assistance (moving the footrest out of the way) before Resident T can transfer safely onto the toilet.

 

 

Toilet transfer: The certified nursing assistant provides steadying (touching) assistance as Resident Z lowers their underwear and then transfers onto the toilet. After voiding, Resident Z cleanses themself. They then stand up as the helper steadies them and Resident Z pulls up their underwear as the helper steadies them to ensure Resident Z does not lose their balance.

Coding: GG0170F would be coded 04, Supervision or touching assistance. Rationale: The helper provides steadying assistance as the resident transfers onto and off the toilet. Assistance with managing clothing and cleansing is coded under item GG0130C, Toileting hygiene and is not considered when rating the Toilet transfer item.

Toilet transfer: The therapist supports Resident M’s trunk with a gait belt by providing weight-bearing as Resident M pivots and lowers themself onto the toilet.

Coding: GG0170F would be coded 03, Partial/moderate assistance.

Rationale: The helper provides less than half the effort to complete the activity. The helper provided weight-bearing assistance as the resident transferred on and off the toilet.

Toilet transfer: Resident W has peripheral vascular disease and sepsis, resulting in lower extremity pain and severe weakness. Resident W uses a bedside commode when having a bowel movement. The certified nursing assistant raises the bed to a height that facilitates the transfer activity. Resident W initiates lifting their buttocks from the bed and in addition requires some of their weight to be lifted by the certified nursing assistant to stand upright. Resident W then reaches and grabs onto the armrest of the bedside commode to steady themself. The certified nursing assistant provides weight-bearing assistance as they slowly rotate and lower Resident W onto the bedside commode.

Coding: GG0170F would be coded 02, Substantial/maximal assistance.

Rationale: The helper provided more than half of the effort for the resident to complete the activity of toilet transfer.

Toilet transfer: Resident H has paraplegia incomplete, pneumonia, and a chronic respiratory condition. Resident H prefers to use the bedside commode when moving their bowels. Due to their severe weakness, history of falls, and dependent transfer status, two certified nursing assistants assist during the toilet transfer.

Coding: GG0170F would be coded 01, Dependent.

Rationale: The activity required the assistance of two or more helpers for the resident to complete the activity.

Toilet transfer: Resident S is on bedrest due to a medical complication. They use a bedpan for bladder and bowel management.

Coding: GG0170F would be coded 88, Not attempted due to medical condition or safety concerns.

Rationale: The resident does not transfer onto or off a toilet due to being on bedrest because of a medical condition.

 

 

Coding Tips for GG0170FF, Tub/shower transfer

Complete GG0170FF when A0310A = 01 – 06 or A0310F = 10 or 11.

Tub/shower transfers involve the ability to get into and out of the tub or shower. Do not include washing, rinsing, drying, or any other bathing activities in this item.

Examples for GG0170FF, Tub/shower transfer

During the observation period, Resident M took one shower. They received physical help from two staff members to get into and out of the shower.

Coding: GG0170FF would be coded 01. Dependent.

Rationale: Resident M required two staff members to assist with shower transfers during the observation period. This represents their usual performance of this activity during the observation period.

 

On Monday, Resident Q required trunk support from one certified nursing assistant to get into and out of the tub. On Wednesday, day 3 of the assessment period, Resident Q required trunk support from one certified nursing assistant to get into the tub and needed assistance lifting their legs during the transfer out of the tub. No other tub or shower transfers occurred during the observation period.

Coding: GG0170FF would be coded 03. Partial/moderate assistance.

Rationale: Resident Q participated in four tub transfers (two transfers into the tub and two transfers out of the tub) during the observation period. They required trunk support for three transfers and required the helper to lift their legs for one transfer. Because the helper performed less than half the effort for three of the four transfers, Resident Q’s usual performance is 03. Partial/moderate assistance.

 

 

Coding Tips for GG0170G, Car transfer

For item GG0170G, Car transfer, use of an indoor car can be used to simulate outdoor car transfers.

The Car transfer does not include getting to or from the vehicle, opening/closing the car door, or fastening/unfastening the seat belt.

If the resident remains in a wheelchair and does not transfer in and out of a car or van seat, then the activity is not considered completed, and the appropriate “activity not attempted” code would be used.

The setup and/or clean-up of an assistive device that is used for walking to and from the car, but not used for the transfer in and out of the car seat, would not be considered when coding the Car transfer activity.

In the event of inclement weather or if an indoor car simulator or outdoor car is not available during the entire assessment period, then use code 10, Not attempted due to environmental limitations.

If at the time of the assessment the resident is unable to attempt car transfers, and could not perform the car transfers prior to the current illness, exacerbation or injury, code 09, Not applicable.

 

Examples for GG0170G, Car transfer

Car transfer: Resident W uses a wheelchair and ambulates for only short distances. They require lifting assistance from a physical therapist to get from a seated position in the wheelchair to a standing position. The therapist provides trunk support when Resident W takes several steps during the transfer turn. Resident W lowers themself into the car seat with steadying assistance from the therapist. They lift their legs into the car with support from the therapist.

Coding: GG0170G would be coded 02, Substantial/maximal assistance.

Rationale: Although Resident W also contributes effort to complete the activity, the helper contributed more than half the effort needed to transfer Resident W into the car by providing lifting assistance and trunk support.

Car transfer: During their rehabilitation stay Resident N works with an occupational therapist on transfers in and out of the passenger side of a car. On the day before discharge, when performing car transfers, Resident N requires verbal reminders for safety and light touching assistance. The therapist instructs them on strategic hand placement while

Resident N transitions to sitting in the car’s passenger seat. The therapist opens and closes the door.

Coding: GG0170G would be coded 04, Supervision or touching assistance. Rationale: The helper provides touching assistance as the resident transfers into the passenger seat of the car. Assistance with opening and closing the car door is not included in the definition of this item and is not considered when coding this item.

 

 

Coding Tips for GG0170I–GG0170L Walking Items

Assessment of the walking activities starts with the resident in a standing position.

A walking activity cannot be completed without some level of resident participation that allows resident ambulation to occur for the entire stated distance. A helper cannot complete a walking activity for a resident.

During a walking activity, a resident may take a brief standing rest break. If the resident needs to sit to rest during a Section GG walking activity, consider the resident unable to complete the walking activity and use the appropriate activity not attempted code.

Clinicians can use clinical judgment to determine how the actual resident assessment of walking is conducted. If a clinician chooses to combine the assessment of multiple walking activities, the clinician should use clinical judgment to determine the type and amount of assistance needed for each individual activity.

Use clinical judgment when assessing activities that overlap or occur sequentially to determine the type and amount of assistance needed for each individual activity.

Walking activities do not need to occur during one session. Allowing a resident to rest between activities or completing activities at different times during the day or on different days may facilitate completion of the activities.

When coding GG0170 walking items, do not consider the resident’s mobility performance when using parallel bars. Parallel bars are not a portable assistive device. If safe, assess and code walking using a portable walking device.

The turns included in item GG0170J, Walk 50 feet with two turns, are 90-degree turns. The turns may be in the same direction (two 90-degree turns to the right or two 90-degree turns to the left) or may be in different directions (one 90-degree turn to the left and one 90-degree turn to the right). The 90-degree turn should occur at the person’s ability level and can include use of an assistive device (for example, cane).

When coding GG0170K, Walk 150 feet, if the resident’s environment does not accommodate a walk of 150 feet without turns, but the resident demonstrates the ability to walk, with or without assistance, 150 feet with turns without jeopardizing the resident’s safety, code using the 6-point scale.

When coding GG0170L, Walking 10 feet on uneven surfaces, the activity can be assessed inside or outside. Examples of uneven surfaces include uneven or sloping surfaces, turf, and gravel. Use clinical judgment to determine whether a surface is uneven.

 

Examples for GG0170I, Walk 10 feet

Walk 10 feet: Resident C has resolving sepsis and has not walked in three weeks because of their medical condition. A physical therapist determines that it is unsafe for Resident C to use a walker, and the resident only walks using the parallel bars. On day 3 of the Admission assessment period, Resident C walks 10 feet using the parallel bars while the therapist provides substantial weight-bearing support throughout the activity.

 

 

Coding: GG0170I would be coded 88, Not attempted due to medical condition or safety concerns.

Rationale: When assessing a resident for GG0170 walking items, do not consider walking in parallel bars, as parallel bars are not a portable assistive device. If the resident is unable to walk without the use of parallel bars because of their medical condition or safety concerns, use code 88, Activity not attempted due to medical condition or safety concerns.

Walk 10 feet: Resident L had bilateral amputations three years ago, and prior to the current admission they used a wheelchair and did not walk. Currently Resident L does not use prosthetic devices and uses only a wheelchair for mobility. Resident L’s care plan includes fitting and use of bilateral lower extremity prostheses.

Coding: GG0170I would be coded 09, Not applicable, not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury.

Rationale: When assessing a resident for GG0170I, Walk 10 feet, consider the resident’s status prior to the current episode of care and current assessment status. Use code 09, Not applicable, because Resident L did not walk prior to the current episode of care and did not walk during the assessment period. Resident L’s care plan includes fitting and use of bilateral prostheses and walking as a goal. A discharge goal for any admission performance item skipped may be entered if a discharge goal is determined as part of the resident’s care plan.

Walk 10 feet: Resident C has Parkinson’s disease and walks with a walker. A physical therapist must advance the walker for Resident C with each step. The physical therapist assists Resident C by physically initiating the stepping movement forward, advancing Resident C’s foot, during the activity of walking 10 feet.

Coding: GG0170I would be coded 02, Substantial/maximal assistance.

Rationale: A helper provides more than half the effort as the resident completes the activity.

 

Walk 10 feet: Resident O has bilateral upper extremity tremors, lower extremity weakness, and Parkinson’s disease. A physical therapist assistant guides and steadies the shaking, rolling walker forward while cueing Resident O to take larger steps. Resident O requires steadying at the beginning of the walk and progressively requires some of their weight to be supported for the last two feet of the 10-foot walk.

Coding: GG0170I would be coded 03, Partial/moderate assistance.

Rationale: The helper provides less than half the effort required for the resident to complete the activity, Walk 10 feet. While the helper guided and steadied the walker during the walk, Resident O supported their own body weight with their arms and legs and propelled their legs forward for 8 of the 10 feet. The helper supported part of Resident O’s weight only for 2 of the 10 feet; thus Resident O contributed more than half the effort.

 

 

Walk 10 feet: Resident U has an above-the-knee amputation and severe rheumatoid arthritis. Once a nurse has donned their stump sock and prosthesis, Resident U is assisted to stand and uses their rolling walker while walking. The nurse places their hand on Resident U’s back to steady them toward the last half of their 10-foot walk.

Coding: GG0170I would be coded 04, Supervision or touching assistance. Rationale: A helper provides touching assistance in order for the resident to complete the activity of Walk 10 feet. Assistance in donning the stump stock, prosthesis, and getting from a sitting to standing position is not coded as part of the Walk 10 feet item.

 

Examples for GG0170J, Walk 50 feet with two turns

Walk 50 feet with two turns: A therapist provides steadying assistance as Resident W gets up from a sitting position to a standing position. After the therapist places Resident W’s walker within reach, Resident W walks 60 feet down the hall with two turns without any assistance from the therapist. No supervision is required while they walk.

Coding: GG0170J would be coded 05, Setup or clean-up assistance.

Rationale: Resident W walks more than 50 feet and makes two turns once the helper places the walker within reach. Assistance with getting from a sitting to a standing position is coded separately under the item GG0170D, Sit to stand (04, Supervision or touching assistance).

Walk 50 feet with two turns: Resident P walks 70 feet with a quad cane, completing two turns during the walk. The therapist provides steadying assistance only when Resident P turns.

Coding: GG0170J would be coded 04, Supervision or touching assistance. Rationale: The helper provides touching assistance as the resident walks more than 50 feet and makes two turns. The resident may use an assistive device.

Walk 50 feet with two turns: Resident L is unable to bear their full weight on their left leg. As they walk 60 feet down the hall with their crutches and make two turns, the certified nursing assistant supports their trunk providing weight-bearing assistance.

Coding: GG0170J would be coded 03, Partial/moderate assistance.

Rationale: The helper provides trunk support as the resident walks more than 50 feet and makes two turns.

Walk 50 feet with two turns: Resident T walks 50 feet with the therapist providing trunk support. They also require a second helper, the rehabilitation aide, who provides supervision and follows closely behind with a wheelchair for safety. Resident T walks the 50 feet with two turns with the assistance of two helpers.

Coding: GG0170J would be coded 01, Dependent.

Rationale: Resident T requires two helpers to complete the activity.

 

 

Walk 50 feet with two turns: Resident U has an above-the-knee amputation, severe rheumatoid arthritis, and uses a prosthesis. Resident U is assisted to stand and, after walking 10 feet, requires progressively more help as they near the 50-foot mark. Resident U is unsteady and typically loses their balance when turning, requiring significant support to remain upright. The therapist provides significant trunk support for about 30 to 35 feet.

Coding: GG0170J would be coded 02, Substantial/maximal assistance.

Rationale: The helper provided more than half of the effort for the resident to complete the activity of walk 50 feet with two turns.

 

Examples for GG0170K, Walk 150 feet

Walk 150 feet: Resident D walks down the hall using their walker and the certified nursing assistant usually needs to provide touching assistance to Resident D, who intermittently loses their balance while they use the walker.

Coding: GG0170K would be coded 04, Supervision or touching assistance. Rationale: The helper provides touching assistance intermittently throughout the activity.

Walk 150 feet: Resident R has endurance limitations due to heart failure and has only walked about 30 feet during the assessment period. They have not walked 150 feet or more during the assessment period, including with the physical therapist who has been working with Resident R. The therapist speculates that Resident R could walk this distance in the future with additional assistance.

Coding: GG0170K would be coded 88, Not attempted due to medical condition or safety concerns, and the resident’s ability to walk a shorter distance would be coded in item GG0170I.

Rationale: The activity was not attempted. The resident did not complete the activity, and a helper cannot complete the activity for the resident. A resident who walks less than 50 feet would be coded in item GG0170I, Walk 10 feet.

Walk 150 feet: Resident T has an unsteady gait due to balance impairment. Resident T walks the length of the hallway using their quad cane in their right hand. The physical therapist supports their trunk, helping them to maintain their balance while ambulating. The therapist provides less than half of the effort to walk the 160-foot distance.

Coding: GG0170K would be coded 03, Partial/moderate assistance.

Rationale: The helper provides less than half of the effort for the resident to complete the activity of walking at least 150 feet.

Walk 150 feet: Resident W, who has Parkinson’s disease, walks the length of the hallway using their rolling walker. The physical therapist provides trunk support and advances Resident W’s right leg in longer strides with each step. The therapist occasionally prevents Resident W from falling as they lose their balance during the activity.

 

 

Coding: GG0170K would be coded 02, Substantial/maximal assistance. Rationale: The helper provides more than half the effort for the resident to complete the activity of walk 150 feet.

 

Example for GG0170L, Walking 10 feet on uneven surfaces

Walking 10 feet on uneven surfaces: Resident N has severe joint degenerative disease and is recovering from sepsis. Upon discharge Resident N will need to be able to walk on the uneven and sloping surfaces of their driveway. During their SNF stay, a physical therapist takes Resident N outside to walk on uneven surfaces. Resident N requires the therapist’s weight-bearing assistance less than half the time during walking in order to prevent Resident N from falling as they navigate walking 10 feet over uneven surfaces.

Coding: GG0170L would be coded 03, Partial/moderate assistance.

Rationale: Resident N requires a helper to provide weight-bearing assistance several times to prevent them from falling as they walk 10 feet on uneven surfaces. The helper contributes less than half the effort required for Resident N to walk 10 feet on uneven surfaces.

 

Coding Tips for GG0170M, 1 step (curb); GG0170N, 4 steps; and GG0170O, 12 steps

Completing the stair activities indicates that a resident goes up and down the stairs, by any safe means, with or without any assistive devices (for example, railing or stair lift) and with or without some level of assistance. Getting to and from the stairs is not included when coding the curb or step activities.

Ascending and descending stairs does not have to occur sequentially or during one session. If the assessment of going up the stairs and then down the stairs occurs sequentially, the resident may take a standing or seated rest break between ascending and descending the 4 steps or 12 steps.

If a resident requires a helper to provide total assist (for example, the resident requires total assist from a helper to move up and down over a curb in their wheelchair), code as 01, Dependent.

A resident who uses a wheelchair may be assessed going up and down stairs (including one step or curb) in a wheelchair. Code based on the type and amount of assistance required from the helper.

If, at the time of the assessment, a resident is unable to complete the activity because of a physician-prescribed restriction (for instance, no stair climbing for two weeks) but could perform this activity prior to the current illness, exacerbation, or injury, code 88, Not attempted due to medical condition or safety concern.

 

 

Assess the resident going up and down one step or up and down over a curb. If both are assessed, and the resident’s performance going up and down over a curb is different from their performance going up and down one step (e.g., because the step has a railing), code GG0170M, 1 step (curb) based on the activity with which the resident requires the most assistance.

If a resident’s environment does not have 12 steps, the combination of going up and down 4 stairs three times consecutively in a safe manner is an acceptable alternative to comply with the intention and meet the requirements of this activity.

 

Example for GG0170M, 1 step (curb)

1. 1 step (curb): Resident Z has had a stroke; they must be able to step up and down one step to enter and exit their home. A physical therapist provides standby assistance as they use their quad cane to support their balance in stepping up one step. The physical therapist provides steadying assistance as Resident Z uses their cane for balance and steps down one step.

Coding: GG0170M would be coded 04, Supervision or touching assistance. Rationale: A helper provides touching assistance as Resident Z completes the activity of stepping up and down one step.

 

Example for GG0170N, 4 steps

4 steps: Resident J has lower body weakness, and a physical therapist provides steadying assistance when they ascend 4 steps. While descending 4 steps, the physical therapist provides trunk support (more than touching assistance) as Resident J holds the stair railing.

Coding: GG0170N would be coded 03, Partial/moderate assistance.

Rationale: A helper provides touching assistance as Resident J ascends 4 steps. The helper provides trunk support (more than touching assistance) when they descend the 4 steps.

 

Example for GG0170O, 12 steps

12 steps: Resident Y is recovering from a stroke resulting in motor issues and poor endurance. Resident Y’s home has 12 stairs, with a railing, and they need to use these stairs to enter and exit their home. Their physical therapist uses a gait belt around their trunk and supports less than half of the effort as Resident Y ascends and then descends 12 stairs.

Coding: GG0170O would be coded 03, Partial/moderate assistance.

Rationale: The helper provides less than half the required effort in providing the necessary support for Resident Y as they ascend and descend 12 stairs.

 

 

Coding Tips for GG0170P, Picking up object

The activity includes the resident bending or stooping from a standing position to pick up a small object, such as a spoon, from the floor.

Picking up the object must be assessed while the resident is in a standing position. If the resident is not able to stand, the activity did not occur, and the appropriate “not attempted” code would be used.

If a standing resident is unable to pick up a small object from the floor, therefore requiring the helper to assist in picking up the object, code as 01, 02, or 03, depending on whether the helper is providing all the effort, more than half of the effort, or less than half of the effort, respectively.

Assistive devices and adaptive equipment may be used, for example, a cane to support standing balance and/or a reacher to pick up the object.

 

Examples for GG0170P, Picking up object

Picking up object: Resident P has a neurologic condition that has resulted in balance problems. They want to be as independent as possible. Resident P lives with their spouse and will soon be discharged from the SNF. They tend to drop objects and have been practicing bending or stooping from a standing position to pick up small objects, such as a spoon, from the floor. An occupational therapist needs to remind Resident P of safety strategies when they bend to pick up objects from the floor, and the occupational therapist needs to steady them to prevent them from falling.

Coding: GG0170P would be coded 04, Supervision or touching assistance. Rationale: A helper is needed to provide verbal cues and touching or steadying assistance when Resident P picks up an object because of their coordination issues.

Picking up object: Resident C has recently undergone a hip replacement. When they drop items they use a long-handled reacher that they have been using at home prior to admission. They are ready for discharge and can now ambulate with a walker without assistance. When they drop objects from their walker basket they require a certified nursing assistant to locate their long-handled reacher and bring it to them in order for them to use it. They do not need assistance to pick up the object after the helper brings them the reacher.

Coding: GG0170P would be coded 05, Setup or clean-up assistance.

Rationale: The helper provides set-up assistance so that Resident C can use their long- handled reacher.

 

 

Coding Tips for GG0170Q, GG0170R, and GG0170S, Wheelchair Items

The intent of the wheelchair mobility items is to assess the ability of residents who are learning how to self-mobilize using a wheelchair or who used a wheelchair for self- mobilization prior to admission. Use clinical judgment to determine whether a resident’s use of a wheelchair is for self-mobilization as a result of the resident’s medical condition or safety.

If the resident used a wheelchair for self-mobilization prior to admission to the facility, indicate 1, Yes, to the gateway wheelchair items on the initial assessment in GG0170Q1.

The responses for gateway wheelchair items (GG0170Q1, GG0170Q3, and/or GG0170Q5) do not have to be the same on subsequent assessments. For example, the Admission assessment may indicate that the resident does not use a wheelchair but the subsequent assessment may indicate that the resident uses a wheelchair.

If a wheelchair is used for transport purposes only, then GG0170Q1, GG0170Q3, and/or GG0170Q5, Does the resident use a wheelchair or scooter? is coded as 0, No; then follow the skip pattern to continue coding the assessment.

Example of using a wheelchair for transport convenience: A resident is transported in a wheelchair by staff between their room and the therapy gym or by family to the facility cafeteria, but the resident is not expected to use a wheelchair after discharge.

The turns included in item GG0170R (wheeling 50 feet with two turns) are 90-degree turns. The turns may be in the same direction (two 90-degree turns to the right or two 90- degree turns to the left) or may be in different directions (one 90-degree turn to the left and one 90-degree turn to the right). The 90-degree turn should occur at the person’s ability level.

If a resident’s environment does not accommodate wheelchair or scooter use for 150 feet without turns, but the resident demonstrates the ability to mobilize a wheelchair or scooter with or without assistance for 150 feet with turns without jeopardizing the resident’s safety, code GG0170S, Wheel 150 feet, using the 6-point scale.

For GG0170S, Wheel 150 feet, a helper can assist a resident in completing the required distance in the wheelchair or in making turns if required. When a resident is unable to wheel the entire distance themself, the activity can still be completed, and a performance code can be determined based on the type and amount of assistance required from the helper to complete the entire activity.

 

 

Example for GG0170Q1, Does the resident use a wheelchair/scooter?

Does the resident use a wheelchair/scooter? On admission, Resident T wheels themself using a manual wheelchair, but with difficulty due to their severe osteoarthritis and COPD.

Coding: GG0170Q1 would be coded 1, Yes. The admission performance codes for wheelchair items GG0170R and GG0170S are coded; in addition, the type of wheelchair Resident T uses for GG0170RR1 is indicated as code 1, Manual. If wheelchair goal(s) are clinically indicated, then wheelchair goals can be coded.

Rationale: The resident currently uses a wheelchair. Coding the resident’s performance and the type of wheelchair (manual) is indicated. Wheeling goal(s) if clinically indicated may be coded.

 

Examples for GG0170R, Wheel 50 feet with two turns, and GG0170RR, Indicate the type of wheelchair/scooter used

Wheel 50 feet with two turns: Resident M is unable to bear any weight on their right leg due to a recent fracture. The certified nursing assistant provides steadying assistance when transferring Resident M from the bed into the wheelchair. Once in their wheelchair, Resident M propels themself about 60 feet down the hall using their left leg and makes two turns without any physical assistance or supervision.

Coding: GG0170R would be coded 06, Independent.

Rationale: The resident wheels themself more than 50 feet. Assistance provided with the transfer is not considered when scoring Wheel 50 feet with two turns. There is a separate item for scoring bed-to-chair transfers.

Indicate the type of wheelchair/scooter used: In the above example Resident M used a manual wheelchair during the assessment period.

Coding: GG0170RR would be coded 1, Manual.

Rationale: Resident M used a manual wheelchair during the assessment period.

Wheel 50 feet with two turns: Resident R is very motivated to use their motorized wheelchair with an adaptive throttle for speed and steering. Resident R has amyotrophic lateral sclerosis, and moving their upper and lower extremities is very difficult. The physical therapist assistant is required to walk next to Resident R for frequent readjustments of their hand position to better control the steering and speed throttle. Resident R often drives too close to corners, becoming stuck near doorways upon turning, preventing them from continuing to mobilize/wheel themself. The physical therapist assistant backs up Resident R’s wheelchair for them so that they may continue mobilizing/wheeling themself.

Coding: GG0170R would be coded 03, Partial/moderate assistance.

Rationale: The helper provided less than half of the effort for the resident to complete the activity, Wheel 50 feet with two turns.

 

 

Indicate the type of wheelchair/scooter used: In the above example Resident R used a motorized wheelchair during the assessment period.

Coding: GG0170RR would be coded 2, Motorized.

Rationale: Resident R used a motorized wheelchair during the assessment period.

Wheel 50 feet with two turns: Resident V had a spinal tumor resulting in paralysis of their lower extremities. The physical therapist assistant provides verbal instruction for Resident V to navigate their manual wheelchair in their room and into the hallway while making two turns.

Coding: GG0170R would be coded 04, Supervision or touching assistance. Rationale: The helper provided verbal cues for the resident to complete the activity, Wheel 50 feet with two turns.

Indicate the type of wheelchair/scooter used: In the above example Resident V used a manual wheelchair during the assessment period.

Coding: GG0170RR would be coded 1, Manual.

Rationale: Resident V used a manual wheelchair during the assessment period.

Wheel 50 feet with two turns: Once seated in the manual wheelchair, Resident R wheels about 10 feet in the corridor, then asks the certified nursing assistant to push the wheelchair an additional 40 feet turning into their room and then turning into their bathroom.

Coding: GG0170R would be coded 02, Substantial/maximal assistance. Rationale: The helper provides more than half the effort to assist the resident to complete the activity.

Indicate the type of wheelchair/scooter used: In the above example Resident R used a manual wheelchair during the assessment period.

Coding: GG0170RR would be coded 1, Manual.

Rationale: Resident R used a manual wheelchair during the assessment period.

Examples for GG0170S, Wheel 150 feet and GG0170SS, Indicate the type of wheelchair/scooter used

Wheel 150 feet: Resident G always uses a motorized scooter to mobilize themself down the hallway and the certified nursing assistant provides cues due to safety issues (to avoid running into the walls).

Coding: GG0170S would be coded 04, Supervision or touching assistance.

Rationale: The helper provides verbal cues to complete the activity.

Indicate the type of wheelchair/scooter used: In the example above, Resident G uses a motorized scooter.

Coding: GG0170SS would be coded 2, Motorized.

Rationale: Resident G used a motorized scooter during the assessment period.

 

 

Wheel 150 feet: Resident N uses a below-the-knee prosthetic limb. Resident N has peripheral neuropathy and limited vision due to complications of diabetes. Resident N’s prior preference was to ambulate within the home and use a manual wheelchair when mobilizing themself within the community. Resident N is assessed for the activity of 150 feet wheelchair mobility. Resident N’s usual performance indicates a helper is needed to provide verbal cues for safety due to vision deficits.

Coding: GG0170S would be coded 04, Supervision or touching assistance. Rationale: Resident N requires the helper to provide verbal cues for their safety when using a wheelchair for 150 feet.

Indicate the type of wheelchair/scooter used: In the above example Resident N used a manual wheelchair during the assessment period.

Coding: GG0170SS would be coded 1, Manual.

Rationale: Resident N used a manual wheelchair during the assessment period.

Wheel 150 feet: Resident L has multiple sclerosis, resulting in extreme muscle weakness and minimal vision impairment. Resident L uses a motorized wheelchair with an adaptive joystick to control both the speed and steering of the motorized wheelchair. They occasionally need reminders to slow down around the turns and require assistance from the nurse for backing up the scooter when barriers are present.

Coding: GG0170S would be coded 03, Partial/moderate assistance.

Rationale: The helper provides less than half of the effort to complete the activity of wheel 150 feet.

Indicate the type of wheelchair/scooter used: Resident L used a motorized wheelchair during the assessment period.

Coding: GG0170SS would be coded 2, Motorized.

Rationale: Resident L used a motorized wheelchair during the assessment period.

Wheel 150 feet: Resident M has had a mild stroke, resulting in muscle weakness in their right upper and lower extremities. Resident M uses a manual wheelchair. They usually can self-propel themself about 60 to 70 feet but need assistance from a helper to complete the distance of 150 feet.

Coding: GG0170S would be coded 02, Substantial/Maximal assistance.

Rationale: The helper provides more than half of the effort to complete the activity of wheel 150 feet.

Indicate the type of wheelchair/scooter used: In the above example, Resident M used a manual wheelchair during the assessment period.

Coding: GG0170SS would be coded 1, Manual.

Rationale: Resident M used a manual wheelchair during the assessment period.

 

 

Wheel 150 feet: Resident A has a cardiac condition with medical precautions that do not allow them to propel their own wheelchair. Resident A is completely dependent on a helper to wheel them 150 feet using a manual wheelchair.

Coding: GG0170S would be coded 01, Dependent.

Rationale: The helper provides all the effort and the resident does none of the effort to complete the activity of wheel 150 feet.

 

Indicate the type of wheelchair/scooter used: In the above example, Resident A is wheeled using a manual wheelchair during the assessment period.

Coding: GG0170SS would be coded 1, Manual.

Rationale: Resident A is assisted using a manual wheelchair during the assessment period.

 

Examples of Probing Conversations with Staff

Sit to lying: Example of a probing conversation between a nurse determining a resident’s score for sit to lying and a certified nursing assistant regarding the resident’s bed mobility:

Nurse: “Please describe how Resident H moves themself from sitting on the side of the bed to lying flat on the bed. When they are sitting on the side of the bed, how do they move to lying on their back?”

Certified nursing assistant: “They can lie down with some help.”

Nurse: “Please describe how much help they need and exactly how you help them.”

Certified nursing assistant: “I have to lift and position their right leg, but once I do that,

they can use their arms to position their upper body.”

In this example, the nurse inquired specifically about how Resident H moves from a sitting position to a lying position. The nurse asked about physical assistance.

Coding: GG0170B would be coded 03, Partial/moderate assistance.

Rationale: The certified nursing assistant lifts Resident H’s right leg and helps them position it as they move from a sitting position to a lying position. The helper does less than half the effort.

 

 

Lying to sitting on side of bed: Example of a probing conversation between a nurse determining a resident’s score for lying to sitting on side of bed and a certified nursing assistant regarding the resident’s bed mobility:

Nurse: “Please describe how Resident L moves themself in bed. When they are in bed, how do they move from lying on their back to sitting up on the side of the bed?”

Certified nursing assistant: “They can sit up by themself.”

Nurse: “They sit up without any instructions or physical help?”

Certified nursing assistant: “No, I have to remind them to check on the position of their arm that has limited movement and sensation as they move in the bed, but once I remind them to check their arm, they can do it themself.”

In this example, the nurse inquired specifically about how Resident L moves from a lying position to a sitting position. The nurse asked about instructions and physical assistance.

Coding: GG0170C would be coded 04, Supervision or touching assistance. Rationale: The certified nursing assistant provides verbal instructions as the resident moves from a lying to sitting position.

Sit to stand: Example of a probing conversation between a nurse determining a resident’s sit to stand score and a certified nursing assistant regarding the resident’s sit to stand ability:

Nurse: “Please describe how Resident L usually moves from sitting on the side of the bed or chair to a standing position. Once they are sitting, how do they get to a standing position?”

Certified nursing assistant: “They need help to get to sitting up and then standing.”

Nurse: “I’d like to know how much help they need for safely rising up from sitting in a chair or sitting on the bed to get to a standing position.”

Certified nursing assistant: “They need two people to assist them to stand up from sitting on the side of the bed or when they are sitting in a chair.”

In this example, the nurse inquired specifically about how Resident L moves from a sitting position to a standing position and clarified that this did not include any other positioning to be included in the answer. The nurse specifically asked about physical assistance.

Coding: GG0170D would be coded 01, Dependent.

Rationale: Resident L requires the assistance of two helpers to complete the activity.

 

 

Chair/bed-to-chair transfer: Example of a probing conversation between a nurse determining a resident’s score for chair/bed-to-chair transfer and a certified nursing assistant regarding the resident’s chair/bed-to-chair transfer ability:

Nurse: “Please describe how Resident C moves into the chair from the bed. When they are sitting at the side of the bed, how much help do they need to move from the bed to the chair?”

Certified nursing assistant: “They need me to help them move from the bed to the chair.”

Nurse: “Do they help with these transfers when you give them any instructions, setup, or physical help?”

Certified nursing assistant: “Yes, they will follow some of my instructions to get ready to transfer, such as moving their feet from being spread out to placing them under their knees. I have to place the chair close to the bed and then I lift them because they are very weak. I then tell them to reach for the armrest of the chair. Resident C follows these directions and that helps a little in transferring them from the bed to the chair. They do help with the transfer.”

In this example, the nurse inquired specifically about how Resident C moves from sitting on the side of the bed to sitting in a chair. The nurse asked about instructions, physical assistance, and cueing instructions. If this nurse had not asked probing questions, they would not have received enough information to make an accurate assessment of the actual assistance Resident C received.

Coding: GG0170E would be coded 02, Substantial/maximal assistance.

Rationale: The helper provides more than half of the effort to complete the activity of Chair/bed-to-chair transfer.

 

 

Toilet transfer: Example of a probing conversation between a nurse determining the resident’s score and a certified nursing assistant regarding a resident’s toilet transfer assessment:

Nurse: “I understand that Resident M usually uses a wheelchair to get to their toilet. Please describe how Resident M moves from their wheelchair to the toilet. How do they move from sitting in a wheelchair to sitting on the toilet?”

Certified nursing assistant: “It is hard for them, but they do it with my help.”

Nurse: “Can you describe the amount of help in more detail?”

Certified nursing assistant: “I have to give them a bit of a lift using a gait belt to get them to stand and then remind them to reach for the toilet grab bar while they pivot to the toilet. Sometimes, I have to remind them to take a step while they pivot to or from the toilet, but they do most of the effort themself.”

In this example, the nurse inquired specifically about how Resident M moves from sitting in a wheelchair to sitting on the toilet. The nurse specifically asked about instructions and physical assistance. If this nurse had not asked probing questions, they would not have received enough information to make an accurate assessment of the actual assistance Resident M received.

Coding: GG0170F would be coded 03, Partial/moderate assistance.

Rationale: The certified nursing assistant provides less than half the effort to complete this activity.

Walk 50 feet with two turns: Example of a probing conversation between a nurse determining a resident’s score for walking 50 feet with two turns and a certified nursing assistant regarding the resident’s walking ability:

Nurse: “How much help does Resident T need to walk 50 feet and make two turns once

they are standing?”

Certified nursing assistant: “They need help to do that.”

Nurse: “How much help do they need?”

Certified nursing assistant: “They walk about 50 feet with one of us holding onto the gait belt and another person following closely with a wheelchair in case they need to sit down.”

In this example, the nurse inquired specifically about how Resident T walks 50 feet and makes two turns. The nurse asked about physical assistance. If this nurse had not asked probing questions, they would not have received enough information to make an accurate assessment of the actual assistance Resident T received.

Coding: GG0170J would be coded 01, Dependent.

Rationale: Resident T requires two helpers to complete this activity.

 

 

Walk 150 feet: Example of a probing conversation between a nurse determining a resident’s score for walking 150 feet and a certified nursing assistant regarding the resident’s walking ability:

Nurse: “Please describe how Resident D walks 150 feet in the corridor once they are

standing.”

Certified nursing assistant: “They use a walker and some help.”

Nurse: “They use a walker and how much instructions or physical help do they need?”

Certified nursing assistant: “I have to support them by holding onto the gait belt that is around their waist so that they don’t fall. They do push the walker forward most of the time.”

Nurse: “Do you help with more than or less than half the effort?”

Certified nursing assistant: “I have to hold onto their belt firmly when they walk because they frequently lose their balance when taking steps. Their balance gets worse the further they walk, but they are very motivated to keep walking. I would say I help them with more than half the effort.”

In this example, the nurse inquired specifically about how Resident D walks 150 feet. The nurse asked about instructions and physical assistance. If this nurse had not asked probing questions, they would not have received enough information to make an accurate assessment of the actual assistance Resident D received.

Coding: GG0170K would be coded 02, Substantial/maximal assistance.

Rationale: The certified nursing assistant provides trunk support that is more than half the effort as Resident D walks 150 feet.

 

 

Wheel 50 feet with two turns: Example of a probing conversation between a nurse determining a resident’s score for wheel 50 feet with two turns and a certified nursing assistant regarding the resident’s mobility:

Nurse: “I understand that Resident R uses a manual wheelchair. Describe to me how Resident R wheels themself 50 feet and makes two turns once they are seated in the wheelchair.”

Certified nursing assistant: “They wheel themself.”

Nurse: “They wheel themself without any instructions or physical help?”

Certified nursing assistant: “Well yes, they need help to get around turns, so I have to help them and set them on a straight path, but once I do, they wheel themself.”

In this example, the nurse inquired specifically about how Resident R wheels 50 feet with two turns. The nurse asked about instructions and physical assistance. If this nurse had not asked probing questions, they would not have received enough information to make an accurate assessment of the actual assistance Resident R received.

Coding: GG0170R would be coded 03, Partial/Moderate assistance.

Rationale: The certified nursing assistant must physically push the wheelchair at some points of the activity; however, the helper does less than half of the activity for the resident.

Wheel 150 feet: Example of a probing conversation between a nurse determining a resident’s score for wheel 150 feet and a certified nursing assistant regarding the resident’s mobility:

Nurse: “I understand that Resident G usually uses an electric scooter for longer distances. Once they are seated in the scooter, do they need any help to mobilize themself at least 150 feet?”

Certified nursing assistant: “They drive the scooter themself … they are very slow.” Nurse: “They use the scooter themself without any instructions or physical help?” Certified nursing assistant: “That is correct.”

In this example, the nurse inquired specifically about how Resident G uses an electric scooter to mobilize themself 150 feet. If this nurse had not asked probing questions, they would not have received enough information to make an accurate assessment of the actual assistance Resident G received.

Coding: GG0170S would be coded 06, Independent.

Rationale: The resident navigates in the corridor for at least 150 feet without assistance.

 

 

Discharge Goals: Coding Tips

 

Discharge goals are coded with each Admission assessment when A0310B = 01, indicating the start of a PPS stay. Discharge goals are not required with stand-alone OBRA assessments.

 

 

 

 

For the SNF QRP, a minimum of one self-care or mobility goal must be coded. However, facilities may choose to complete more than one self-care or mobility discharge goal. Code the resident’s discharge goal(s) using the six-point scale. Identifying multiple goals helps to ensure that the assessment accurately reflects resident status and facilitates person-centered individualized care planning. Use of “activity not attempted” codes (07, 09, 10, and 88) is permissible to code discharge goal(s). The use of a dash is permissible for any remaining self-care or mobility goals that were not coded. Using the dash in this allowed instance after the coding of at least one goal does not affect APU determination.

Licensed qualified clinicians can establish a resident’s discharge goal(s) at the time of admission based on the resident’s prior medical condition, admission assessment self- care and mobility status, discussions with the resident and family, professional judgment, practice standards, expected treatments, resident motivation to improve, anticipated length of stay, and the resident’s discharge plan. Goals should be established as part of the resident’s care plan.

If the performance of an activity was coded 88, Not attempted due to medical condition or safety concerns, during the Admission assessment, a discharge goal may be coded using the six-point scale if the resident is expected to be able to perform the activity by discharge.