GG0130: CMS OASIS Q&As

The intent of GG0130A - Eating is to assess the patient’s ability to use suitable utensils to bring food and/or liquids to the mouth and swallow food and/or liquid once the meal is placed before the patient. When assessing GG0130A - Eating, allow the patient to complete the activity of eating as independently as possible as long as they are safe.

The intent of GG0130A - Eating is to assess the patient’s ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the patient. At SOC/ROC, the self-care or mobility performance code is to reflect the patient’s baseline ability to complete the activity, prior to the benefit of services provided by your agency staff. In the scenario provided, use Code 05 - Setup or clean-up assistance for GG0130A - Eating if this represents the patient’s baseline status. Use of an “activity not attempted” code should only be used if the patient was not able to complete the activity prior to the benefit of services and the performance code cannot be determined based on patient/caregiver report, collaboration with other agency staff, or assessment of similar activities.

The intent of GG0130A - Eating is to assess the patient’s ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the patient. In the scenario provided, if the patient only required assistance to apply a universal cuff, and no further assistance was required during the eating activity, code 05 - Setup or clean-up assistance. This is because assistance is required prior to or following the activity, but not during the activity.

The intent of GG0130A - Eating is to assess the patient’s ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the patient. The adequacy of the patient’s nutrition or hydration is not considered for GG0130A - Eating. When coding activities in Section GG, clinicians should code based on the type and amount of assistance required allowing the patient to perform the activity as independently as possible, as long as they are safe. If the patient is able to meet the intent of the activity with no assistance (physical, verbal/nonverbal cueing, setup/clean-up) then code 06 - Independent.

GG0130C - Toileting Hygiene includes “the ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment.” Toileting hygiene includes managing undergarments, clothing, and incontinence pad/briefs, etc., and performing perineal hygiene. If the patient can complete toileting hygiene and clothing management tasks only after a helper retrieves or sets up supplies necessary to perform included tasks, code 05 - Setup or clean-up assistance. In situations where a definitive answer to an assessing clinician’s question is not contained in published CMS OASIS guidance (OASIS Guidance Manual, Q&As, etc.), the clinician may have to rely on clinical judgment to determine how to code the item, ensuring that the response coded does not conflict with current guidance.

We interpret your question to indicate that the patient does not wear underwear/briefs. If the patient does not wear underwear, nor any other type of clothing that just covers their lower body, code GG0130G - Lower body dressing with the appropriate “activity not attempted” code. Any assistance provided by a helper to put on or remove the dress or Mumu would be considered when coding GG0130F - Upper body dressing.

The intent of the items GG0130F - Upper body dressing and GG0130G - Lower body dressing is to assess the patient’s ability to dress and undress above the waist (GG0130F) and below the waist (GG0130G); including fasteners, if applicable. It is not the type of assistance that is provided that determines Code 05 - Setup or clean-up assistance but rather when (related to the completion of the activity) the needed assistance is provided. If the assistance provided is necessary only before or after the activity is completed, and no assistance is needed during the completion of the activity, select Code 05 - Setup or clean-up assistance.

The intent of GG0130G - Lower body dressing is to assess the patient’s ability to dress and undress below the waist, including fasteners, if applicable, in clothing routinely worn by the patient. At SOC/ROC, the self-care or mobility performance code is to reflect the patient’s baseline ability to complete the activity, prior to the benefit of services provided by your agency staff. Clinicians should use clinical judgment to determine if observing the patient dress and undress in the lower body clothing (i.e., underwear) worn during the first assessment allows the clinician to adequately determine the patient’s ability to complete the activity of lower body dressing (GG0130G) in clothing routinely worn by the patient. If the clinician determines that this observation is adequate, code based on the type and amount of assistance the patient requires.

For the GG0130 and GG0170 items, the assessing clinician would code based on the type and amount of assistance needed to complete the activity safely, not based on the availability of such assistance. The assessing clinician can be the helper on the day of assessment in order to determine which code 06 - 01 accurately reflects the needed assistance to complete the activity, rather than using a “activity not attempted” code 07, 09, 10, or 88, solely because the patient does not have a caregiver.

Yes, the day of assessment convention applies to GG0130 - Self-Care and GG0170 Mobility. For most OASIS items, including the function items, the time period under consideration is the “day of assessment”, which is defined as the 24 hours immediately preceding the home visit and the time spent by the clinician in the home. For GG0130 and GG0170, code the patient’s functional status based on a functional assessment that occurs at or soon after the patient’s start of care/resumption of care (SOC/ROC). The SOC/ROC function scores are to reflect the patient’s SOC/ROC baseline status and are to be based on observation of activities, to the extent possible. Other assessment strategies include coding patient functional status based on patient and/or caregiver report. When using patient or caregiver report, it is expected that the patient and caregiver are reporting on the patient’s status within the time period under consideration, (e.g., reporting on the patient’s ability to complete the car transfer within the past 24 hours).

In the situation you describe the helper and patient each are providing exactly half of the effort to complete a GG activity. If the patient performs exactly half of the effort, code the activity 03 - Partial/moderate assistance.

When assessing self-care and mobility activities, allow the patient to complete each activity as independently as possible, as long as they are safe. At Start of Care/Resumption of Care (SOC/ROC), the self-care or mobility performance code is to reflect the patient’s baseline ability to complete the activity prior to the benefit of services provided by your agency staff. This may be achieved by having the patient attempt the activity prior to providing any instruction that could result in a more independent code, and then coding based on the type and amount of assistance that was required prior to the benefit of services provided by your agency staff. Communicating the activity request (e.g., “Can you stand up from the toilet?”) would not be considered verbal cueing. If additional prompts are required in order for the patient to safely complete the activity (e.g., “Push down on the grab bar”, etc.), the assessing clinician may need to use clinical judgment to determine the most appropriate code, utilizing the Coding Section GG Activities Decision Tree found at https://www.cms.gov/Medicare/QualityInitiatives-Patient- Assessment-Instruments/HomeHealthQualityInits/HHQIOASISUserManual In the scenarios described, assuming the verbal cues were only required prior to the activity, were provided prior to the benefit of services, and no other assistance was needed in order for the patient to complete the activity safely, then the verbal cues fit the definition for Code 05 Setup or clean-up assistance.

At Start of Care/Resumption of Care (SOC/ROC), the self-care or mobility performance code is to reflect the patient’s baseline ability to complete the activity, prior to the benefit of services provided by your agency staff. Use of an “activity not attempted” code should occur only after determining that the activity is not completed prior to the benefit of services, and the performance code cannot be determined based on patient/caregiver report, collaboration with other agency staff, or assessment of similar activities. “Prior to the benefit of services” means prior to provision of any care by your agency staff that would result in more independent coding. In your scenario, if the patient’s baseline status prior to the benefit of services was that the activity could not be completed due to a medical or safety concern and the performance code could not be determined based on patient/caregiver report, collaboration with other agency staff, or assessment of a similar activity, code 88 - Not attempted due to medical condition or safety concerns, even if the patient’s status changes and they are able to complete the activity on a later day during the assessment timeframe.

At Start of Care/Resumption of Care (SOC/ROC) the self-care or mobility performance code is to be based on a functional assessment that occurs at or soon after the patient’s SOC/ROC and reflect the patient’s baseline ability to complete the activity prior to the benefit of services provided by your agency staff. “Prior to the benefit of services” means prior to provision of any care by your agency staff that would result in more independent coding. When the baseline function code differs from the usual performance during the assessment timeframe, report the baseline function code. If in your scenario, the patient being unable to complete the sit to stand activity due to medical condition or safety concerns represents their baseline ability, then code 88 - Not attempted due to medical condition or safety concerns.

When assessing and coding GG activities allow the patient to perform the activity as independently as possible, as long as they are safe. As stated, code based on the type and amount of assistance required to complete the activity, not based on the availability of assistance. For example, a patient requires a physical therapist to provide assistance to ambulate 10 feet safely. However, when the therapist is not available, the patient is unable to ambulate 10 feet safely. The walking activity would be coded based on the type and amount of assistance required (assistance to walk 10 feet), even though a physical therapist may not always be available to provide the needed assistance.