Step-by-Step Coding Guide for Item Set GG0170L1: Walk 10 Feet (Admission Performance)

This guide provides detailed instructions for accurately coding and documenting a resident's ability to walk 10 feet upon admission, as outlined in item GG0170L1 of the MDS 3.0.

1. Review of Medical Records

• Objective: Determine the resident's capability to walk 10 feet upon admission.
• Key Points:
  • Carefully review the resident's medical records, including nursing assessments, physical and occupational therapy evaluations, and physician notes for any mention of the resident's ability to walk 10 feet.
  • Look for assessments that specifically evaluate the resident's gait, balance, use of assistive devices, and need for human assistance.

2. Understanding Definitions

• Objective: Clarify the activity "Walk 10 Feet."
• Key Points:
  • Walk 10 Feet: Refers to the resident's ability to walk 10 feet in a straight line, which may involve turning if space requires. This assessment considers the resident's need for physical assistance, supervision, or the use of assistive devices.

3. Coding Instructions

• Objective: Document the resident's admission performance in walking 10 feet accurately.
• Key Points:
  • Utilize the following scale to code performance:
    • 6: Independent
    • 5: Setup or clean-up assistance
    • 4: Supervision or touching assistance
    • 3: Partial/moderate assistance
    • 2: Substantial/maximal assistance
    • 1: Dependent
  • Code 88 if the activity did not occur during the assessment period.

4. Coding Tips

• Base the coding on the resident’s most dependent episode of walking 10 feet during the first three days of the current SNF stay.
• Consider the entire walking process, including the initiation of walking, maintaining balance, and stopping.

5. Documentation

• Objective: Ensure detailed documentation to support the coding decision.
• Key Points:
  • Record observations regarding the resident's ability to walk 10 feet, noting any assistance needed, use of equipment, or environmental adaptations.
  • Document specific conditions or impairments that affect the resident's ability to walk 10 feet and any interventions planned or provided.

6. Common Errors to Avoid

• Not accounting for occasional assistance or the use of assistive devices when coding, potentially overestimating the resident's independence.
• Overlooking documentation from the interdisciplinary team that may provide additional insights into the resident's walking ability.

7. Practical Application

• Scenario: Upon admission, Mr. Thomas required substantial assistance to walk 10 feet due to recent surgery on his leg. Physical therapy evaluations detailed his need for two staff members to support him during walking, indicating a significant level of assistance. Thus, he is coded as 2 (substantial/maximal assistance) in GG0170L1.

The Step-by-Step Coding Guide for item GG0170L1 in MDS 3.0 Section GG is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.