THE DIFFERENCES BETWEEN G & GG | Why Section G is still important | GG pays but G gets the praise

Section GG vs G Section GG has been getting all the attention since the rollout of PDPM because as an industry we tend to focus on areas that reimburse. And rightfully so! We should be getting paid for the level of care we provide as we as paint the pictures of our residents’ abilities, strengths and weaknesses. But with the increased focus on Section GG many facilities are losing critical points on their Five Star and QRPs ratings. Keep reading to ensure your facility is accurately reporting the key ADLs in section G to keep your Five Star rating where is should be.

Quality Measures and QRPs

Do you know which sections of the QM and QRP are affected by section G? More importantly, do your CNAs and Therapy personnel know? Let's dig into the details to make sure you’re coding correctly!

Of course, Long-Stay Resident’s Whose Need for Help with ADLs Has Increased is the obvious one! It continues to focus on the 4 late loss ADLS and monitors for declines from previous MDS assessments so quarter to quarter accuracy is crucial.

Long-stay QM Resident’s Whose Ability to Move Independently worsened is affected by coding of locomotion on the unit (G0110E) and is also risk adjusted by covariates in section G items including eating, toileting, transferring and walking in the corridor.

Long-Stay High Risk Residents with a Pressure Ulcer is affected by Self-Performance of Bed Mobility and Transfers. Miscoding a resident in this area could make them trigger this measure inappropriately.

Another Section G item that won’t hit your 5 star report, but can definitely affect survey outcomes is Low Risk Residents Who Lose Control of their Bowel or Bladder. Correct coding for Self-Performance in Bed Mobility, Transfers and Locomotion on the Unit is very helpful. Not only does it show personalized care, but also draws attention to the interventions the facility is using to help them with their toileting and bathroom needs.

That’s it for the Long-Stay items on the QM Report, but there is one Short-Stay items as well.

Short Stay Residents Who Made Improvements in Function is a big one that often gets miscoded. For many years we’ve trained CNAs that we need to capture the highest level of care we can. However, it is more important to focus on accuracy. With increased focus on improving the function of our short-stay residents for a successful discharge, we need to ensure section G Self-performance in Transfers (G0110B1), Walking in the Corridor (G0110D1) and Locomotion on the Unit (G0110E1).

Section GG

Things to keep in mind

The Quality Reporting Program (QRP) focuses on many care items as well. This report is important for us since it used by hospitals and other referral sources to determine how well their patients do after they are discharged to us. Poor QRPs could mean less referrals.

One example is Lying to Sitting on Side of Bed (GG0170C1) on admission. This item is used for the Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury Measure. It is used to determine the functional limitation covariate for each Medicare Part A SNF stay.

Functional outcomes play a bigger role than ever before and our patients’/residents’ outcomes will only continue to rise in importance. Change in Self-Care and Change in Mobility Measures use Section GG by comparing the level of function on admission and discharge. These items have a complex covariate so accuracy is critical here.

Of course, we should always strive for complete accuracy when coding any component of the MDS, but it doesn’t hurt to keep in mind the GG questions that affect case mix: GG0130A1, GG0130B1, GG0130C1, GG0170B1, GG0170C1, GG0170D1, GG0170E1, GG0170F1, GG0170I (gateway question), GG0170J1, and GG0170K1.

Key Takeaways

Section G and Section GG are two important sections of the MDS and are quite often miscoded resulting in lower reimbursement rates and QM ratings.

Need good documentation to back up Section GG i.e. why resident refused, why it was safe, notes from family and resident interviews as well as CNA and Nurses notes.

GG measures INDEPENDENCE

G measures DEPENDENCE

It’s no secret that Section GG will continue to grow in importance so it is important to have a strong IDT collaboration in order to ensure accuracy.

Take some time each month to review your QMs, QRPs and Review and Correct reports and analyze your findings. This will show you where you may have opportunities for improvement in care, documentation or even MDS coding.

Conclusion

While it is very important to maintain your systems and collaboration for accurately coding Section GG for reimbursement, care planning and QRP purposes, don’t fall into the trap that Section G doesn’t matter anymore. CMS has talked about removing Section G in the future, but until then, continue to educate, document and code Section G with great accuracy!

What is your plan to educate your staff on this important component of your quality program?

MDS Solutions HQ

Do you want to take your facility to the next level? Let MDS Solutions HQ show you where your opportunities are. Whether it’s improved quality of care, better survey outcomes or if revenue is your focus it all begins with the MDS.

I specialize in training MDS nurses in the RAI process, training floor nurses to document skilled need, educating revenue capture through the PDPM process, analyzing and creating action plans for QM and 5 star success.

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