Improper Coding for MDS Item G0110 Could Cause Changes to RUG Values
Nursing facility and skilled nursing facility providers must use the proper activities of daily living (ADL) coding when completing column 1 of item G0110 on the MDS 3.0 assessment. The Texas Health and Human Services Commission (HHSC) Office of the Inspector General (OIG) staff have announced that improper coding could cause changes to RUG values during Medicaid reviews.
While neither federal nor state rules specifically mandate the form or format for ADL self-performance coding, providers must use the performance-based scale from the MDS 3.0 RAI Manual when coding item G0110.
Page G-2 of the MDS 3.0 RAI Manual states:
ADL SELF-PERFORMANCE: Measures what the resident actually did (not what he or she might be capable of doing) within each ADL category over the last 7 days according to a performance-based scale.
Coding Instructions for G0110, Column 1, ADL Self-Performance
The performance-based scale is listed below. It also can be found on pages G-4 to G-5 of the MDS 3.0 RAI Manual.
• Code 0, independent: if resident completed activity with no help or oversight every time during the 7-day look-back period and the activity occurred at least three times.
• Code 1, supervision: if oversight, encouragement, or cueing was provided three or more times during the last 7 days.
• Code 2, limited assistance: if resident was highly involved in activity and received physical help in guided maneuvering of limb(s) or other non-weight-bearing assistance on three or more times during the last 7 days.
• Code 3, extensive assistance: if resident performed part of the activity over the last 7 days and help of the following type(s) was provided three or more times:
o Weight-bearing support provided three or more times, OR
o Full staff performance of activity three or more times during part but not all of the last 7 days.
• Code 4, total dependence: if there was full staff performance of an activity with no participation by resident for any aspect of the ADL activity and the activity occurred three or more times. The resident must be unwilling or unable to perform any part of the activity over the entire 7-day look-back period.
• Code 7, activity occurred only once or twice: if the activity occurred fewer than three times.
• Code 8, activity did not occur: if the activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day look-back period.
To Learn More
Questions regarding coding of Section G of MDS 3.0 assessments can be directed to Cheryl Shiffer at 210-619-8010 or by email at cheryl.shiffer@dads.state.tx.us.
Questions regarding HHSC OIG Medicaid reviews can be directed to Carolyn Larson at 512-491-1750 or by email at carolyn.larson@hhsc.state.tx.us.
