83239-4 Prior Functioning: Everyday Activities

Observation ID in Form

GG0100

Skip Logic

Complete only if A0310B = 01

Form Coding Instructions

Indicate the resident's usual ability with everyday activities prior to his/her most recent illness, exacerbation, or injury

Fully-Specified Name

Component

IRF-PAI v3.0, MDS v1.17.1, 1.17.2, OASIS E - Prior functioning: everyday activities

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.61

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Release 2.72: COMPONENT: Updated to include current version of OASIS that uses this panel; Release 2.69: COMPONENT: Updated to state the current active versions of each form that use this panel.; Previous Releases: Removed "IRF-PAI" from Component because this panel is used in both the IRF-PAI and OASIS

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Outcome and assessment information set
• Pan
• Panel
• PANEL.SURVEY.CMS
• Panl
• Pnl
• Report period
• Survey

Related Codes

85070-1 Self-Care

Term Description

Need for assistance with bathing, dressing, using the toilet, and eating prior to the current illness, exacerbation, or injury.
Source: Regenstrief LOINC

Observation ID in Form

GG0100A

Form Coding Instructions

Code the resident's need for assistance with bathing, dressing, using the toilet, and eating prior to the current illness, exacerbation, or injury

Fully-Specified Name

Component

Prior functioning.self care

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.61

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Change Component display to match Component, like similar terms

Order vs. Observation

Observation

Normative Answer List LL4970-1

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Self-care
• Survey

Related Codes

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

85071-9 Indoor Mobility (Ambulation)

Term Description

Need for assistance with walking from room to room (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury.
Source: Regenstrief LOINC

Observation ID in Form

GG0100B

Form Coding Instructions

Code the resident's need for assistance with walking from room to room (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury

Fully-Specified Name

Component

Prior functioning.indoor mobility-ambulation

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.61

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4970-1

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

85072-7 Stairs

Term Description

Need for assistance with internal or external stairs (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury.
Source: Regenstrief LOINC

Observation ID in Form

GG0100C

Form Coding Instructions

Code the resident's need for assistance with internal or external stairs (with or without a device such as cane, crutch, or walker) prior to the current illness, exacerbation, or injury

Fully-Specified Name

Component

Prior functioning.stairs

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.61

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4970-1

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

85073-5 Functional Cognition

Term Description

Need for assistance with planning regular tasks, such as shopping or remembering to take medication prior to the current illness, exacerbation, or injury.
Source: Regenstrief LOINC

Observation ID in Form

GG0100D

Form Coding Instructions

Code the resident's need for assistance with planning regular tasks, such as shopping or remembering to take medication prior to the current illness, exacerbation, or injury

Fully-Specified Name

Component

Prior functioning.functional cognition

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.61

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4970-1

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

83234-5 Prior Device Use

Term Description

Devices and aids used by the patient prior to the current illness, exacerbation, or injury.
Source: Regenstrief LOINC

Observation ID in Form

GG0110

Skip Logic

Complete only if A0310B = 01

Form Coding Instructions

Indicate devices and aids used by the resident prior to the current illness, exacerbation, or injury. Check all that apply

Fully-Specified Name

Component

Prior device use

Property

Type

Time

RptPeriod

System

^Patient

Scale

Nom

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.61

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4152-6

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Nominal
• Report period
• Survey
• Typ

Related Codes

95732-4 Self-Care - Admission Performance

Observation ID in Form

GG0130_1

Skip Logic

v1.17.1: Complete only if A0310B = 01; v1.17.2: If state requires completion with an OBRA assessment, complete only column 1.

Form Coding Instructions

(Assessment period is days 1 through 3 of the SNF PPS Stay starting with A2400B) Code the resident's usual performance at the start of the SNF PPS stay (admission) for each activity using the 6-point scale. If activity was not attempted at the start of the SNF PPS stay (admission), code the reason. Code the resident's end of SNF PPS stay (discharge) goal(s) using the 6-point scale. Use of codes 07, 09, 10, or 88 is permissible to code end of SNF PPS stay (discharge) goal(s). Safety and Quality of Performance - If helper assistance is required because resident's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices

Form Coding Instructions

If A0310B = 01, the assessment period is days 1 through 3 of the SNF PPS Stay starting with A2400B. If state requires completion with an OBRA assessment, the assessment period is the ARD plus 2 previous days; complete only column 1

Fully-Specified Name

Component

IRF-PAI v3.0, MDS v1.17.1, 1.17.2 - Self-care - admission performance

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.69

Last Updated

Version 2.77

Change Reason

Release 2.70: COMPONENT: Updated to include the current active versions of MDS that use this panel.;

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Pan
• Panel
• PANEL.SURVEY.CMS
• Panl
• Pnl
• Report period
• Survey

Related Codes

95019-6 Eating

Term Description

The patient's usual ability to use suitable utensils to bring food/liquid to the mouth and swallow food once the meal is presented on a table/tray. Includes modified food consistency.
Source: Regenstrief LOINC

Observation ID in Form

GG0130A1

Form Context

The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident

Fully-Specified Name

Component

Eating - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95018-8 Oral hygiene

Observation ID in Form

GG0130B1

Form Context

The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment

Fully-Specified Name

Component

Oral hygiene - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95017-0 Toileting hygiene

Observation ID in Form

GG0130C1

Form Context

The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment

Fully-Specified Name

Component

Toileting hygiene - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95015-4 Shower/bathe self

Observation ID in Form

GG0130E1

Form Context

The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower

Fully-Specified Name

Component

Shower &or bathe self - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95014-7 Upper body dressing

Observation ID in Form

GG0130F1

Form Context

The ability to dress and undress above the waist; including fasteners, if applicable

Fully-Specified Name

Component

Upper body dressing - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• bod
• Bodies
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey
• Up

Related Codes

95013-9 Lower body dressing

Observation ID in Form

GG0130G1

Form Context

The ability to dress and undress below the waist, including fasteners; does not include footwear

Fully-Specified Name

Component

Lower body dressing - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• bod
• Bodies
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Low
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95012-1 Putting on/taking off footwear

Observation ID in Form

GG0130H1

Form Context

The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable

Fully-Specified Name

Component

Putting on &or taking off footwear - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

89478-2 Self-Care - Discharge Goal

Observation ID in Form

GG0130_2

Skip Logic

v1.17.1: Complete only if A0310B = 01; v1.17.2: If state requires completion with an OBRA assessment, complete only column 1.

Form Coding Instructions

(Assessment period is days 1 through 3 of the SNF PPS Stay starting with A2400B) Code the resident's usual performance at the start of the SNF PPS stay (admission) for each activity using the 6-point scale. If activity was not attempted at the start of the SNF PPS stay (admission), code the reason. Code the resident's end of SNF PPS stay (discharge) goal(s) using the 6-point scale. Use of codes 07, 09, 10, or 88 is permissible to code end of SNF PPS stay (discharge) goal(s). Safety and Quality of Performance - If helper assistance is required because resident's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices

Form Coding Instructions

If A0310B = 01, the assessment period is days 1 through 3 of the SNF PPS Stay starting with A2400B. If state requires completion with an OBRA assessment, the assessment period is the ARD plus 2 previous days; complete only column 1

Fully-Specified Name

Component

IRF-PAI v3.0, MDS v1.17.1, 1.17.2, OASIS E - Self-care - discharge goal

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Release 2.72: COMPONENT: Updated to include current version of OASIS that uses this panel; Release 2.70: COMPONENT: Updated to state the current active versions of MDS that use this panel.; Release 2.69: COMPONENT: Updated to state the current active versions of IRF-PAI and OASIS that use this panel.;

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Disch
• Outcome and assessment information set
• Pan
• Panel
• PANEL.SURVEY.CMS
• Panl
• Pnl
• Report period
• Survey

Related Codes

89404-8 Oral hygiene - functional goal during assessment period [CMS Assessment]

Fully-Specified Name

Component

Oral hygiene - functional goal

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4681-4

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

89409-7 Eating

Observation ID in Form

GG0130A2

Fully-Specified Name

Component

Eating - functional goal

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

89389-1 Toileting hygiene

Observation ID in Form

GG0130C2

Form Context

The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment

Fully-Specified Name

Component

Toileting hygiene - functional goal

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

89396-6 Shower/bathe self

Observation ID in Form

GG0130E2

Form Context

The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower

Fully-Specified Name

Component

Shower &or bathe self - functional goal

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

89387-5 Upper body dressing

Observation ID in Form

GG0130F2

Form Context

The ability to dress and undress above the waist; including fasteners, if applicable

Fully-Specified Name

Component

Upper body dressing - functional goal

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• bod
• Bodies
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey
• Up

Related Codes

89406-3 Lower body dressing

Observation ID in Form

GG0130G2

Form Context

The ability to dress and undress below the waist, including fasteners; does not include footwear

Fully-Specified Name

Component

Lower body dressing - functional goal

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• bod
• Bodies
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Low
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

89400-6 Putting on/taking off footwear

Observation ID in Form

GG0130H2

Form Context

The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable

Fully-Specified Name

Component

Putting on and taking off footwear - functional goal

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.64

Last Updated

Version 2.77

Change Reason

Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95741-5 Mobility - Admission Performance

Observation ID in Form

GG0170_1

Skip Logic

v1.17.1: Complete only if A0310B = 01; v1.17.2: If state requires completion with an OBRA assessment, complete only column 1.

Form Coding Instructions

(Assessment period is days 1 through 3 of the SNF PPS Stay starting with A2400B) Code the resident's usual performance at the start of the SNF PPS stay (admission) for each activity using the 6-point scale. If activity was not attempted at the start of the SNF PPS stay (admission), code the reason. Code the resident's end of SNF PPS stay (discharge) goal(s) using the 6-point scale. Use of codes 07, 09, 10, or 88 is permissible to code end of SNF PPS stay (discharge) goal(s). Safety and Quality of Performance - If helper assistance is required because resident's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices

Form Coding Instructions

If A0310B = 01, the assessment period is days 1 through 3 of the SNF PPS Stay starting with A2400B. If state requires completion with an OBRA assessment, the assessment period is the ARD plus 2 previous days; complete only column 1

Fully-Specified Name

Component

IRF-PAI v3.0, MDS v1.17.1, 1.17.2 - Mobility - admission performance

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.69

Last Updated

Version 2.77

Change Reason

Release 2.70: COMPONENT: Updated to include most recent versions of MDS that use this panel.;

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Pan
• Panel
• PANEL.SURVEY.CMS
• Panl
• Pnl
• Report period
• Survey

Related Codes

95011-3 Roll left and right

Observation ID in Form

GG0170A1

Form Context

The ability to roll from lying on back to left and right side, and return to lying on back on the bed

Fully-Specified Name

Component

Roll left and right - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• L
• LT
• Ordinal
• Ql
• Qual
• Qualitative
• R
• Report period
• RT
• Screen
• Survey

Related Codes

95010-5 Sit to lying

Observation ID in Form

GG0170B1

Form Context

The ability to move from sitting on side of bed to lying flat on the bed

Fully-Specified Name

Component

Sit to lying - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95009-7 Lying to sitting on side of bed

Observation ID in Form

GG0170C1

Form Context

The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor and with no back support

Fully-Specified Name

Component

Lying to sitting on side of bed - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9

Member of these Panels

Related Names

• ADL
• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• FunctionalStatus
• IADL
• Ordinal
• QL
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

95008-9 Sit to stand

Observation ID in Form

GG0170D1

Form Context

The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed

Fully-Specified Name

Component

Sit to stand - usual functional ability

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.68

Last Updated

Version 2.69

Order vs. Observation

Observation

Normative Answer List LL4971-9