The Challenge
The Centers for Medicare & Medicaid Services (CMS) addressed concerns regarding GG codes in the recently released Outcome Assessment Information Set (OASIS) Q&As for quarter 1 of 2021.
Clinicians still find it challenging to correctly assess and code the functional M items and the GG items since the revision of OASIS from version C to D in 2019. Previously used for patient assessments in skilled nursing and in-patient rehabilitation facilities, GG items did not always transition easily to home health. The confusion lies in how clinicians are inclined to follow long-standing OASIS advice to avoid contradictory answers on the functional M items. They are often confused about what is and is not supposed to be considered when assessing the patient for GG items because they are so familiar with M item assessments.
There may be specific tasks that are common to GG items and functional M items, but it does not mean that they should exactly match. However, using a 6-point scale, the GG scoring for the patient’s performance on a task during the Start of Care (SOC) and the Resumption of Care (ROC) can really help the clinicians to also score the functional M items correctly.
The Difference
What’s the difference between M items and GG items? M items cover a broader spectrum and must be carefully filtered through aspects of patient safety, environmental factors, and other circumstances, and be based on all available information, including evaluations and assessments. The GG items require a more narrow evaluation of only the specific task being assessed.
One major difference between M items and GG items is how the “majority of tasks” convention is applied. This convention applies when a patient’s ability to perform a task varies. Guidance from CMS tells clinicians to follow the “majority of tasks” convention when assessing M items but not when assessing GG items.
The GG items focus on the functional abilities and goals assessed by the clinician during SOC and ROC. Using the 6-point scaling system, the points reflect the patient’s SOC/ROC baseline functional status as observed by the clinicians during the patient’s activities. Similar to functional M items, the GG sections also take into account factors that impact the patient’s functional ability, such as the environment or situations encountered in the home. In addition, this section requires the clinician to identify the patient’s goal upon discharge.
On the other hand, the intent of functional M items (M1800s) is to identify the patient’s ability to safely perform instrumental activities of daily living (IADLs) associated with a specific task, but not necessarily the actual performance. Timelines and activities considered for GG items are often different from similar M items for IADLs.
One thing to note with GG items is that they are very specific on the activities the patient needs to perform, including the required assistance. Meanwhile, the M1800s responses describe the patient’s ability to perform more than 50% of activities under one task at a given time period under consideration.
The Solution
The differences between GG and functional M items mean that clinicians should consider each item individually and code it according to the guidelines specific to that item. Being diligent in staying up to date with the OASIS guidance released by CMS through quarterly Q&As is the key.
The section GG has no right or wrong answer as long as it is a true reflection of the patient’s performance of the task. It is a process that requires careful assessment and evaluation from the clinicians. Keenly observing the patient’s performance of each task can greatly help in correctly coding the GG and functional M items.
New clinicians who just entered the home health industry may find documenting the OASIS assessment quite confusing. It will be helpful for home health agencies to partner with outsourcing providers who are knowledgeable of the OASIS Guidance Manual and know the application of the OASIS item conventions. They can help corroborate the clinicians’ assessment findings with other supporting medical documentation to make the OASIS assessment more cohesive, especially on the M items and section GG.
Mastery of OASIS documentation takes time. One must understand the intent of each section, including the M items. Without adequate knowledge and support, this could compromise the quality of care, reimbursement value, and most importantly, patient outcomes.
