SNF toolkit
Section GG Scoring Scale
Every Section GG item uses the same scale: six performance levels based on how much helper effort the resident needs, plus four codes recording why an activity was not attempted. Score usual performance, not best performance, and admission scores should reflect status before the benefit of skilled services.
Reference
| Code | Level | Definition |
|---|---|---|
| 06 | Independent | Resident completes the activity by themself safely, with no helper assistance |
| 05 | Setup or clean-up assistance | Helper assists only before or after the activity; resident completes the activity itself |
| 04 | Supervision or touching assistance | Helper provides verbal cues, steadying, or contact guard as the resident completes the activity; may be needed throughout |
| 03 | Partial/moderate assistance | Helper does less than half the effort; lifts, holds, or supports trunk or limbs with less than half the effort |
| 02 | Substantial/maximal assistance | Helper does more than half the effort; lifts or holds trunk or limbs providing more than half the effort |
| 01 | Dependent | Helper does all the effort, or two or more helpers are required |
Score usual performance during the assessment period. Admission scores reflect status prior to the benefit of skilled services.
Source: CMS GG Decision Tree
| Code | Meaning |
|---|---|
| 07 | Resident refused |
| 09 | Not applicable: resident did not perform this activity prior to the current illness, exacerbation, or injury |
| 10 | Not attempted due to environmental limitations |
| 88 | Not attempted due to medical condition or safety concerns |
Never leave an item blank; use the code that records why the activity was not assessed. Verify against the current RAI Manual.
Source: CMS RAI Manual (MDS 3.0)
Coding notes
- The 03 versus 02 line is the highest-stakes distinction: it turns entirely on whether the helper does less than half or more than half of the effort. Document the helper effort, not just the resident effort.
- Two or more helpers automatically codes as 01 Dependent, regardless of how much the resident participates.
- 04 covers a wide band: verbal cueing only, steadying, and contact guard all code the same. Note the actual assist type in the narrative even though the code does not distinguish them.
- Avoid defaulting to not-attempted codes; observe the activity whenever safe. Overuse of 07/09/10/88 can depress quality measures.
- Usual performance across the assessment window, not a single best or worst trial, drives the code.
References
- Centers for Medicare & Medicaid Services. Coding Section GG Self-Care & Mobility Activities: Decision Tree. cms.gov
- Centers for Medicare & Medicaid Services. Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, Chapter 3, Section GG. Verify against the current version at cms.gov. cms.gov