Dorothy
Dorothy's referral lists 3 prescription medications. At the SOC visit you ask about other medications. She says she takes a baby aspirin every morning, a calcium supplement, and Tylenol as needed?
How many total medications does Dorothy have for M1033 purposes?
What is 6?
( 3 prescription medications, baby aspirin, calcium supplement, tylenol)
Based on information how many M1033 risk factors are present based on referral information alone — before you even visit Betty?
What is 3?
Betty chronic conditions, oxygen use, 4+ medications
Raymond's daughter completed the intake paperwork and listed him as 'independent in all ADLs.' During the SOC visit you ask Raymond directly about bathing. He says: 'I sit on a tub bench. I can wash most of myself but my son helps with my back and feet when he visits — which is about 4 days a week.'
The correct M1830 (Bathing)
What is 2?
Intermittent assistance: Patient can bathe in shower or tub but requires intermittent help from another person.
Connie's physician order includes PT for 'continued knee rehab.' The hospital admission was for pneumonia and IV antibiotics. SN has been ordered for medication management and IV antibiotic administration.
Primary diagnosis/focus of care
What is pneumonia?
This is the primary skilled service. The knee rehab is a continuation of a previous issue.
Sylvia walks to the kitchen without her walker during the SOC visit. Her husband pulls you aside afterward and says: 'She does that every time someone comes over. At home she always uses the walker — she fell last week without it. I have to keep reminding her to use it and go slow'
The correct answer for M1860 is
What is 3?
Sylvia requires a two-handed device as well as supervision to ensure she is being safe and using the device correctly
During the SOC visit, Dorothy walks from her bedroom to the bathroom independently. You notice she runs her hand along the wall the entire way. Her daughter follows behind because mom is "nervous she may fall again".
The correct answer for M1860 ambulation
What is 3?
- Able to walk only with supervision or assistance of another person at all times.
At the SOC visit, Betty's husband says Betty 'usually' needs his help to get dressed — particularly with buttons and overhead shirts because of her breathlessness. During the visit Betty dresses herself slowly but completely while you are present. She says: 'I wanted to show you I can still do things myself.'
The correct answer for M1810
What is 2?
Someone must help the patient put on upper body clothing. (Consider what patient is usually able to do not what they do to prove they can do it)
James uses a quad cane and walks slowly but steadily during the visit. He tells you: 'I only use the cane when I go any distance — around the house I usually hold onto furniture or the wall with my hands.' He has had 2 falls in the past 3 months, neither requiring hospitalization.
Correct answer for 1860
What is 2?
At times James uses a one-handed device but other times he is placing both hands on the wall or furniture for assistance.
Connie has lost 9 pounds in 6 weeks. She is 5'4" and weighed 142 lbs before the illness. She reports fatigue and limited appetite. She is not on oxygen, has not been previously hospitalized this year, and takes Metformin, Lisinopril, a probiotic, and acetaminophen PRN.
Number of M1033 risk factors
What is 2?
Unintentional weight loss, 4+ medications
Sylvia tells you she cannot put on her own shoes or socks since the surgery — she can't bend that far yet. She can put on her shirt and zip her jacket independently. She says she 'manages' her bra with difficulty but needs help clasping it.
Correct M1810 (Dress Upper) score?
What is 2?
Sylvia requires assistance as evidenced by her difficulty with putting on her bra
Dorothy reports her daughter helps her wash her lower legs and feet every time she bathes 'because of the wound.' She uses a shower chair and does the rest herself.
The correct answer for M1830 bathing
What is 5?
Unable to use shower/tub, but able to participate in bathing in bed, at sink, in bedside chair, or on commode, with another person present throughout for assistance/supervision
Betty completes toilet transfers during the visit without assistance however her husband stays close by. He tells you she 'sometimes needs a hand' getting up from lower seats, and that they installed a raised toilet seat last month specifically because she was struggling. Betty confirms: 'Yeah, without the raised seat I'd need help.'
The correct answer for M1840
What is 1?
Patient is able to use the toilet but requires an assistive device and supervision
James has a sacral pressure injury. He takes Metoprolol, lisinopril, Coumadin, Tylenol regularly, and a multivitamin. His daughter says he has seemed 'a little forgetful lately' but Raymond denies any memory issues. He has not been hospitalized in 14 months.
Number of M1033 hospitalization risk factors
What is 3?
Medications, skin breakdown, cognitive impairment
During the SOC visit Connie walks to the kitchen independently without any assistive device. She moves slowly due to fatigue but completes it without incident. When you ask about her usual function she says: 'Before I got sick I walked fine. Right now, I get winded easily and I hold onto things when I'm tired, which is most of the time.'
Correct answer for M1860 is
What is 2?
Patient requires the assistance of walls and furniture to ambulate
Sylvia has hypertension and osteoporosis as secondary diagnoses. She takes Lisinopril, alendronate, calcium with vitamin D (OTC), and ibuprofen PRN for knee pain. She has not been hospitalized in 2 years beyond the current knee replacement admission. She has no weight loss, no oxygen, no skin breakdown, no cognitive issues.
Number of hospitalization risk indicators for M1033
What is 1?
Sylvia takes 4+ medications
Dorothy has mild arthritis and struggles to open childproof pill bottles. Her daughter fills a weekly pill organizer for her every Sunday. The patient independently takes the correct pills at the correct times every day from the prefilled organizer and never misses a dose.
M2020 answer
What is 1?
Able to take medication(s) at the correct times if individual doses are prepared in advance by another person
Upon assessment you learn Betty has quit smoking 6 months ago. She has lost 7 pounds in the past 8 weeks — her husband says her appetite has been poor since the CHF flare. She was hospitalized for the current CHF exacerbation and had a prior ER visit for shortness of breath 5 months ago that resulted in a 1-night admission.
Number of risk factors for M1033 hospitalization risk
What is 5?
chronic conditions, oxygen use, 4+ medications, multiple rehospitalizations, unintentional weight loss
James lives alone and takes 4 oral medications daily. He is able to open her pill bottles, read the labels, and correctly sort her medications into a weekly pill planner. However, he occasionally forgets whether she has already taken her morning dose and sometimes skips or double-doses without realizing it. No one is available to supervise or remind her.
Answer for M2020
What is 2?
Able to take medication(s) at the correct times if: (a) individual doses are prepared in advance OR (b) given daily reminders
At the start of care visit, Connie is observed transferring from sitting in a chair to standing. She moves slowly due to fatigue and left knee pain but is able to stand without physical assistance. The nurse stays nearby due to her recent illness and unsteady pace, but Connie does not require hands-on help. She completes the transfer safely after a brief pause.
Correct GG0170C (Sit to Stand) answer
What is 4?
Supervision or touching assistance
During the SOC visit Sylvia, he confidently shows you how he manages his medications. She correctly names each medication, opens the bottles, and fills her weekly pill organizer without difficulty. He states, “I’ve been doing this for years—I don’t need any help.”
Later in the visit, you notice her pill organizer has several evening doses still in place from earlier in the week, and when asked, she says, “Sometimes I forget if I already took them, so I just skip it to be safe.” She does not use reminders and has no caregiver support.
What is 2?
Able to take medication(s) at the correct times if: (a) individual doses are prepared in advance OR (b) given daily reminders
Dorothy has COPD is comfortable at rest and has no shortness of breath while sitting or lying down. When walking from the living room to the kitchen (about 20 feet), the patient becomes short of breath and needs to stop to catch their breath. They recover after resting for a minute. They do not report shortness of breath while dressing or eating.
Correct response for M1400
What is 2?
With moderate exertion (e.g., while dressing, using commode, or walking distances less than 20 feet)
Betty sleeps in a bed on the lower level of her home. In the morning she is able to sit up in bed and watch television. When her daughter wakes up she helps her get into her recliner chair and helps lift her legs. She then sits there to eat breakfast.
Correct answer for M1850 transferring
What is 3?
Unable to transfer self and is unable to bear weight or pivot when transferred by another person.
James is 83 years old and admitted for a sacral pressure injury. He has had two falls in the past 3 months and uses a quad cane for mobility. He is alert, cognitively intact, and slow-moving. During the visit, the nurse observes James putting on his pants and socks. He is able to thread both legs through his pants and pull them up, but he needs help from his daughter to pull the pants fully over his hips in the back for safety and balance. He is able to don socks independently while seated.
Correct GG0130C answer
What is 3?
Partial/moderate assistance. He can thread legs into pants independently. He can don socks independently. He only needs help with the final portion (pulling pants fully over hips for balance/safety)
During the SOC visit, Connie walks from the living room to the kitchen (about 15 feet) without a cane. She moves slowly due to fatigue but completes the walk without loss of balance. The nurse stands beside her throughout the walk because Connie states, “I get really winded and sometimes I need to grab the counter when I feel unsteady.” The nurse provides steadying touch once when Connie reaches for the counter, although Connie continues walking without stopping.
When asked about usual function, Connie reports that at home she often holds onto furniture when she is tired.
Correct answer GG0170E (Walk 10 feet
What is 4?
Supervision or touching assistance. Even though she completed the walk she required touching assistance
Sylvia has a diagnosis of CHF. During the SOC visit, she is sitting comfortably in his chair and denies shortness of breath at rest. While talking with you, she becomes slightly short of breath but continues speaking in full sentences. When she walks about 10 feet to the bathroom, she becomes noticeably short of breath and needs to stop halfway to catch his breath. She reports, “I get winded just moving around the house or even when I’m talking too much.”
Correct answer for M1400 Dyspnea
What is 3?
With minimal exertion (e.g., while eating, talking, or performing other ADLs)