MDS 3.0 U pdates O ctober 2019- Part 2

1. MDS 3.0 Updates October 2019- Part 2

2. GG0170-Mobility (3-day assessment period) Admission/Interim/ Discharge (Start/Interim/End of Medicare Part A stay)

3. GG0170-Mobility Admission Performance (3-Day Assessment Period)

4. GG0170-Mobility Admission Performance (3-Day Assessment Period) (continued)

5. GG0170A-GG0170D Bed Mobility Items

6. GG0170A-GG0170D-Bed Mobility Items • Code GG0170A (Roll left & Right), GG0170B (Sit to Lying); GG0170C(Lying to sitting on side of bed); and GG0170D ( Sit to stand) “88, Not Attempted due to medical condition or safety concern” if: • The 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.

7. GG0170A-GG0170C(continued) • For GG0170A (Roll left & Right), GG0170B (Sit to Lying); GG0170C (Lying to sitting on side of bed), Use your clinical judgement to determine what is considered a “lying” position for resident. • Note: the bed mobility items should be assessed on a bed, not on a raised mat. This includes for GG0170A, GG0170 B, and GG0170C.

8. GG0170A- Roll Left and Right

9. GG0170B- Sit to Lying

10. GG0170C- Lying to Sitting on Side of Bed

11. GG0170C(continued) • The activity includes resident transitions from lying on his/her back to sitting on the side of the bed with his/her feet flat on the floor and sitting upright on the bed without back support. • If a resident’s feet do not reach the floor upon lying to sitting, determine if a bed height adjustment or a footstool is required to accommodate foot placement on the floor/ footstool.

12. GG0170D-GG0170G Transfer Items

13. GG0170D- Sit to Stand

14. GG0170E- Chair/Bed-to-Chair Transfer

15. GG0170E (continued) • Item GG0170E, Chair/bed-to-chair transfer, begins with the resident sitting in a chair or wheelchair or sitting upright at the edge of the bed and returning to sitting in a chair or wheelchair or sitting upright at the edge of the bed. • 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.

16. GG0170F-Toilet Transfer

17. GG0170F- Toilet Transfer (continued) • Do not include GG0130C -Toileting hygiene item tasks when assessing the Toilet transfer item. • Transferring on and off a bedpan is not included in Toilet transfer.

18. GG0170G- Car Transfer

19. GG0170G- Car Transfers (continued) • The Car transfer item includes the resident’s ability to transfer in and out of the passenger seat of a car or car simulator. • The Car transfer item does not include: • Transfers into the driver’s seat. • Opening/closing the car door. • Fastening/unfastening the seat belt. • 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.

20. GG0170G- Car Transfers (continued) • Use of an indoor car can be used to simulate outdoor car transfers. • These half or full cars would need to have similar physical features of a real car for the purpose of simulating a car transfer, that is, a car seat within a car cabin. • In the event of inclement weather or if an indoor car simulator or outdoor car is not available during the entire 3 - day assessment period, then use of Code 10, Not attempted due to environmental limitations.

21. GG0170I-GG0170L Walking Items

22. Walking Items • Walking activities do not need to occur during one session. • When coding GG0170 walking items, do not consider the resident’s mobility performance when using parallel bars. • Code 88 “Activity not attempted due to medical condition or safety concern” if : • The resident cannot walk without the use of parallel bars due to his/her medical condition or safety concerns.

23. Walking Items (continued) • 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 • 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.

24. GG0170I -Walk 10 Feet 24 24

25. GG0170I - Walk 10 Feet (continued) • If GG0170I (Walk 10 feet) coded 07, 09, 10, 88 skip to GG0170M (1 Step Curb). • If the admission performance of an activity was coded using one of the “activity not attempted” codes, a discharge goal may be submitted using the six-point scale if the resident is expected to be able to perform the activity by discharge. • Use of assistive device(s) and adaptive equipment required to complete the walking activity should not affect coding of the activity.

26. GG0170J-Walk 50 Feet with two turns

27. GG0170K - Walk 150 Feet

28. GG0170L - Walk 10 Feet on Uneven Surface

29. GG0170M-GG0170P Steps Items & Picking Up Object

30. GG0170M-Ability to go up & down a curb/ one step

31. GG0170M(continued) • If GG0170M “1 Step (curb)” admission performance code 07, 09, 10, 88 skip to GG0170P (Picking up objects). • If the admission performance of an activity was coded using one of the “activity not attempted” codes (07, 09, 10, or 88), a discharge goal may be submitted using the six-point scale if the resident is expected to be able to perform the activity by discharge.

32. GG0170N- Ability to go up & down four steps with/ without a rail

33. GG0170N (continued) • If GG0170N- “4 Steps (curb)” admission performance code 07, 09, 10, 88 skip to GG0170P. • If the admission performance of an activity was coded using one of the “activity not attempted” codes (07, 09, 10, or 88), a discharge goal may be submitted using the six-point scale if the resident is expected to be able to perform the activity by discharge. • Use of assistive device(s) and adaptive equipment required to complete the walking activity should not affect coding of the activity.

34. GG0170O- 12 Steps

35. GG0170P- Picking Up Object

36. GG0170Q1-GG0170SS1 Wheelchair Items

37. GG0170Q1- Does the resident use a Wheelchair and/or Scooter?

38. GG0170Q1(continued) • 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 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; or • For staff convenience.

39. GG0170Q1(continued) • Code the wheelchair gateway items (GG0170Q1 and/or GG0170Q3) at admission and /or discharge “0, No”, and skip all remaining wheelchair questions if: • The resident walks and is not learning how to mobilize in a wheelchair. • Only uses a wheelchair for transport between locations within the facility. • Only uses a wheelchair for staff convenience (e.g., because the resident walks slowly).

40. GG0170Q1(continued) • Only code wheelchair mobility based on an assessment of the resident’s ability to mobilize in the wheelchair. • Admission assessment for wheelchair items should be coded for residents who used a wheelchair prior to admission. • The responses for gateway admission and discharge wheelchair items (GG0170Q1 and GG0170Q3) do not have to be the same on the Admission and Discharge assessments.

41. GG0170Q1(continued) • 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 • 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.

42. GG0170R- Wheel 50 Feet with Two Turns

43. GG0170RR1 & GG0170SS1- Indicate the type of wheelchair and/or scooter Used

44. GG0170S-Wheel 150 Feet

45. Section I Active Diagnoses

46. Section I(continued) • The items in this section are intended to code diseases that have a direct relationship to the resident’s: • Current functional status. • Cognitive status. • Mood or behavior status. • Medical treatments. • Nursing monitoring. • Risk of death.

47. I0020- Indicate the resident’s Primary Medical Condition category Old

48. I0020 (continued) New

49. I0020 (continued) • The following information was added to I0020 under “Coding Instructions”: • Complete only if A0310B = 01 or 08 • Indicate the resident’s primary medical condition category that best describes the primary reason for the Medicare Part A stay; then proceed to I0020B and enter the International Classification of Diseases (ICD) code for that condition, including the decimal.

50. I0020 (continued) • I0020A changed to I0020B. • Enter the code that represents the primary medical condition that resulted in the resident’s admission to the SNF and proceed to I0020B to enter the ICD Code (with decimal).