November 18 2024
OASIS

Discharge Function Score Quality Measure: Part 2 – GG Function Assessment Strategies

by Megan Bernier, MSPT RAC-CT COS-C

With the Discharge Function Score quality measure being added to Care Compare in January 2025 and in the HHVBP CY 2025 Performance Year applicable measure set, it’s more important then ever to understand the accurate coding of the GG items used in the calculation of the measure.

This blog is Part 3 of a 3-part series on the Discharge Function Score Quality Measure.

Part 1 – GG Items and Measure Overview
Part 2 – GG Assessment Strategies
Part 3 – How Activity Not Attempted Codes and Assistive Devices Impact Coding GG Items

GG Function Item Assessment Strategies

Accurate measure results for the Discharge Function Score quality measure require accurate coding of the activities included in the measure, specifically GG0130 Self-Care and GG0170 Mobility. In addition to knowing and understanding the CMS-approved guidance associated with the GG activities, clinicians need assessment strategies for completing their patient assessments and selecting the accurate code for each activity.

In addition to observation, which we know will provide the most complete picture of the patient’s status, CMS also allows the use of collaboration with other agency staff, considering reports of the patient’s status from the patient and/or caregivers, as well as assessment of similar activities to code the GG activities. Utilizing all these assessment strategies may allow a clinician to select a performance code for an activity they are not able to observe the patient perform in the time spent in the patient’s home.

Here are some useful tips when utilizing an assessment strategy other than observation:

If the patient only completes a portion of the activity (e.g., performs a partial bath or transfers into but not out of a vehicle) and does not complete the entire activity during the assessment timeframe, use clinical judgment to determine if the situation allows the clinician to adequately assess the patient’s ability to complete the activity. If the clinician determines that this observation is adequate, code based on the type and amount of assistance the patient requires to complete the ENTIRE activity. If the clinician determines the partial activity does not provide adequate information to support determination of a performance code, select an appropriate “activity not attempted” code.
When using patient or caregiver reports, it is expected that the patient and caregivers are reporting on the patient’s status within the time period under consideration (e.g., reporting on the patient’s ability to complete an activity within the past 24 hours).
In situations where specific equipment may not be available (e.g., 12 steps, a vehicle), the assessing clinician may determine that assessment of a similar activity adequately represents the patient’s ability to complete the activity. This practice will serve to minimize the use of an “activity not attempted” code in favor of a performance code determined to represent the patient’s status in the given self-care or mobility activity. While CMS does not provide specific parameters or a complete list of what is and is not an acceptable proxy activity, providers are expected to use clinical judgment in determining if the “similar activity” meets the intent of the target activity to make it a reasonable substitute when making a coding determination.

SOC/ROC Assessment

It’s also important to remember that when capturing the patient’s status at Start of Care and Resumption of Care the goal is to report the patient’s baseline ability to complete the activity. This is their ability prior to the benefit of services provided by your agency’s staff. Remember “prior to the benefit of services” means prior to provision of any care by your agency staff that would result in more independent coding.

Capturing the patient’s baseline ability at SOC/ROC 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.

Some things that should NOT be considered “providing a service” for section GG include:

Introducing a new device
Communicating an activity request

Coming soon! The OASIS Answers blog: Discharge Function Score Quality Measure: Part 3 – How Activity Not Attempted Codes and Assistive Devices Impact Coding GG Items.