Eating
Eating assistance provided by family can be counted. True or False?
What is false?
The managing of denture soaking and rinsing is included in oral hygiene. True or False?
What is True?
The ability to adjust clothes before and after voiding is not included in Toileting Hygiene. True or False?
What is False?
The starting point to assess sit to lying begins with the resident sitting on the side of the bed. True or False.
What is True?
Mr. B pushes up from the bed to get himself from a lying to a seated position. The therapist provides steadying (touching) assistance as Mr. B scoots himself to the edge of the bed and lowers his feet onto the floor. How do you code Lying to Sitting?
What is 04 Supervision or Touching Assistance?
Sit-to-stand includes the ability to come to a standing position from a toilet or commode. True or False?
What is False? (toilet/commode is included in toilet transfers)
Sitting upright at the edge of the bed can be a starting position when assessing the GG item Chair/Bed Transfer? True or False?
What is True?
Mrs. Q transfers onto and off the elevated toilet seat with the occupational therapist supervising due to her unsteadiness. How do you code toilet transfer?
What is 04, Supervision or touching assistance?
Since Mr. W uses a quad cane, he cannot be considered independent for the Section GG walking items. True or False?
What is False?
The resident needs to be able to demonstrate turns when assessing 150 feet? True or False?
What is False?
The dietary aide opens all of Mr. S’ cartons and containers on his food tray before leaving the room. There are no safety concerns regarding Mr. S’ ability to eat. Mr. S eats the food himself, bringing the food to his mouth, using appropriate utensils, and swallowing the food safely. How do you code eating?
What is 05 set up or clean up assistance?
Mr. G has Parkinson’s disease, resulting in tremors and incoordination. The occupational therapy assistant retrieves all oral hygiene items for Mr. G and applies toothpaste to his toothbrush. Mr. G requires assistance to guide the toothbrush into his mouth and to steady his elbow while he brushes his teeth. Mr. G usually starts by brushing his upper and lower front teeth and the OT assistant completes the activity by brushing the rest of his teeth. How do you code oral hygiene?
What is 02 Substantial/Maximal Assistance? (Helper does more than half)
Mrs. L uses the toilet to void and have bowel movements. Mrs. L is unsteady, so the occupational therapist walks into the bathroom with her in case she needs help. During the assessment period, the OT has been present in the bathroom, but has not needed to provide any physical assistance with managing clothes or cleansing. How do you code toileting hygiene?
What is 04 Supervision or Touching Assistance?
Mrs. H requires assistance from a therapist to transfer from sitting at the edge of the bed to lying flat on the bed because of paralysis on her right side. The helper lifts and positions Mrs. H’s right leg. Mrs. H uses her arms to position her upper body and lowers herself to a lying position flat on her back. How do you code Sit to Lying?
What is 03 Partial/Moderate Assistance?
The resident’s feet do not reach the floor upon lying to sitting. Is the therapist allowed to adjust the bed height to accommodate foot placement on the floor when assessing Lying to Sitting? True or False?
What is True?
Ms. Z has amyotrophic lateral sclerosis with moderate weakness in her lower and upper extremities. Ms. Z has prominent foot drop in her left foot, requiring the use of an ankle foot orthosis (AFO) for standing and walking. The therapist applies Ms. Z’s AFO and places the platform walker in front of her; Ms. Z uses the walker to steady herself once standing. The therapist provides lifting assistance to get Ms. Z to a standing position and must also provide assistance to steady Ms. Z’s balance to complete the activity. How do you code sit to stand?
What is 02 Substantial/Maximal Assistance?
Mr. L had a stroke and currently is not able to walk. He uses a wheelchair for mobility. When Mr. L gets out of bed, the therapist moves the wheelchair into the correct position and locks the brakes so that Mr. L can transfer into the wheelchair safely. Mr. L had been observed several other times to determine any safety concerns, and it was documented that he transfers safely without the need for supervision. Mr. L transfers into the wheelchair by himself (no helper) after the therapist leaves the room. How do you code Chair/Bed Transfer?
What is 05 Setup or clean-up assistance?
The ability to get on and off a bed pan is included in the assessment of Toilet Transfer. True or False?
What is False? (Toilet transfer only includes ability to get on and off a toilet or commode)
A therapist provides steadying assistance as Mrs. W gets up from a sitting position to a standing position. After the therapist places Mrs. W’s walker within reach, Mrs. W walks 60 feet down the hall with two turns without any assistance from the therapist. No supervision is required while she walks. How do you code walk 50 feet?
What is 05, Setup or clean-up assistance?
Mr. W, who has Parkinson’s disease, walks the length of the hallway using his rolling walker. The physical therapist provides trunk support and advances Mr. W’s right leg in longer strides with each step. The therapist occasionally prevents Mr. W from falling as he loses his balance during the activity. How do you code walk 150 feet?
What is 02, Substantial/Maximal Assistance?
Mrs. H does not have any food consistency restrictions, but often needs to swallow 2 or 3 times so that the food clears her throat due to difficulty with pharyngeal peristalsis. She requires verbal cues from the certified nursing assistant to use the compensatory strategy of extra swallows to clear the food. How do you code eating?
What is 04 Supervision or Touching Assistance? (Swallowing assistance is included in eating)
Mr. W is edentulous (without teeth) and his dentures no longer fit his gums. In the morning and evening, Mr. W begins to brush his upper gums after the helper applies toothpaste onto his toothbrush. He brushes his upper gums, but cannot finish due to fatigue. The occupational therapist completes the activity of oral hygiene by brushing his back upper gums and his lower gums. How do you code oral hygiene?
What is 02 Substantial/Maximal Assistance? (Staff performed more than half)
Mrs. P has urinary urgency. As soon as she gets in the bathroom, she asks the occupational therapist to lift her gown and pull down her underwear due to her balance problems. After voiding, Mrs. P wipes herself, pulls her underwear back up, and adjusts her gown. How do you code toileting hygiene?
What is 03 Partial/Moderate Assistance?
Mr. F had a stroke about 2 weeks ago and is unable to sequence the necessary movements to complete an activity (apraxia). He can maneuver himself when transitioning from sitting on the side of the bed to lying flat on the bed if the therapist provides verbal instructions as to the steps needed to complete this task. How do you code Sit to Lying?
What is 04 Supervision or Touching Assistance?
Resident is unable to recline in bed due to shortness of breath. Lying to sitting can still be assessed from this position. True or False?
What is False? (If the therapist determines that bed mobility cannot be assessed because of the degree to which the head of the bed must be elevated because of a medical condition, then you would code 88)
Mr. B has complete paraplegia and is currently unable to stand when getting out of bed. Prior to his current illness, Mr. B used a slide board at home and did not stand. How do code sit to stand?
What is 09 Not Applicable? (Resident did not perform this activity prior to the current illness)
Mr. U had his left lower leg amputated due to gangrene associated with his diabetes mellitus and he has reduced sensation and strength in his right leg. He has not yet received his below-the-knee prosthesis. Mr. U uses a transfer board for chair/bed-to-chair transfers. The therapist places the transfer board under his buttock. Mr. U then attempts to scoot from the bed onto the transfer board. Mr. U has reduced sensation in his hands and limited upper body strength, but assists with the transfer. The physical therapist assists him in side scooting by lifting his buttocks/trunk in a rocking motion across the transfer board and into the wheelchair. How do you code Chair/Bed Transfer?
What is 02 Substantial/Maximal Assistance?
The therapist supports Mrs. M’s trunk with a gait belt by providing weight-bearing as Mrs. M pivots and lowers herself onto the toilet. How do you code toilet transfer?
What is 03 Partial/Moderate Assistance?
Walk 50 feet with two turns: Mr. T walks 50 feet with the therapist providing trunk support. He also requires a second helper, the rehabilitation aide, who provides supervision and follows closely behind with a wheelchair for safety. Mr. T walks the 50 feet with two turns with the assistance of two helpers. How do you code walk 50 feet?
What is 01 Dependent? (2 helpers is always dependent)
Mr. R has endurance limitations due to heart failure and has only walked about 30 feet during the 3-day assessment period. He has not walked 150 feet or more during the assessment period, including with the physical therapist who has been working with Mr. R. The therapist speculates that Mr. R could walk this distance in the future with additional assistance. How do you code walk 150 feet?
What is 88, Not attempted due to medical condition?
Mr. R is unable to eat by mouth since he had a stroke one week ago. He receives nutrition through a gastrostomy tube (G-tube), which is administered by nurses. How do you code eating?
What is 88 Not attempted due to Medical Condition or Safety Concerns?
Ms. T has Lewy body dementia and multiple bone fractures. She does not understand how to use oral hygiene items nor does she understand the process of completing oral hygiene. The occupational therapist brushes her teeth and explains each step of the activity to engage cooperation from Ms. T; however, she requires full assistance for the activity of oral hygiene. How do you code oral hygiene?
What is 01 Dependent?
Mr. J is morbidly obese and has a diagnosis of debility. He requests the use of a bedpan when voiding or having bowel movements and requires moderate assistance to pull down his pants and underwear and mobilize him onto and off the bedpan. Mr. J is unable to complete any of his perineal/perianal hygiene. Two therapy assistants help Mr. J pull up his underwear and pants. How do you code toileting hygiene?
What is 01 Dependent? (The assistance of 2 or more helpers id dependent regardless of the fact he was able to participate in some of the task)
Mrs. E suffered a pelvic fracture during a motor vehicle accident. Mrs. E requires the therapist to lift and position her left leg when she transfers from sitting at the edge of the bed to lying flat on the bed due to severe pain in her left pelvic area. Mrs. E uses her arms to position and lower her upper body to lying flat on the bed. How do you code Sit to Lying?
What is 03 Partial/Moderate Assistance?
Mr. B pushes up on the bed to attempt to get himself from a lying to a seated position as the occupational therapist provides much of the lifting assistance necessary for him to sit upright. The occupational therapist provides additional lifting assistance as Mr. B scoots himself to the edge of the bed and lowers his feet to the floor. How do you code Lying to Sitting?
What is 02 Substantial/Maximal Assistance?
Mr. T is a new admission with a right hip fracture. He required moderate assistance from both physical and occupational therapist to move him sit to stand from the bed. Once in the therapy gym, the resident was able to move sit to stand from a straight back chair with minimal assistance of only the physical therapist 2 times. How do you code sit to stand?
What is 03 Partial/Moderate Assistance? (Usual performance, not the best, not the worst, the usual)
Ms. P has metastatic bone cancer, severely affecting her ability to use her lower and upper extremities during daily activities. Ms. P is motivated to assist with her transfers from the side of her bed to the wheelchair. Ms. P pushes herself up from the bed to begin the transfer while the therapist provides limited trunk support with weight-bearing assistance. Once standing, Ms. P shuffles her feet, turns, and slowly sits down into the wheelchair with the therapist providing trunk support with weight-bearing assistance. How do you code Chair/Bed Transfer?
What is 03 Partial/Moderate Assistance?
Mrs. B is able to transfer to the toilet without help once the therapist places the bedside commode next to her bed. How do you code toilet transfer?
What is 05 Set up or Clean up Assistance?
Mrs. U has an above-the-knee amputation, severe rheumatoid arthritis, and uses a prosthesis. Mrs. U is assisted to stand and, after walking 10 feet, requires progressively more help as she nears the 50-foot mark. Mrs. U is unsteady and typically loses her balance when turning, requiring significant support to remain upright. The therapist provides significant trunk support for about 30 to 35 feet. How do you code walk 50 feet?
What is 02 Substantial/Maximal Assistance? (The helper provided more than half of the assistance)
Mrs. T has an unsteady gait due to balance impairment. Mrs. T walks the length of the hallway using her quad cane in her right hand. The physical therapist supports her trunk, helping her to maintain her balance while ambulating. The therapist provides less than half of the effort to walk the 160-foot distance. How do you code walk 150 feet?
What is 03, Partial/Moderate Assistance?
Mrs. M has osteoporosis, which contributed to the fracture of her right wrist and hip during a recent fall. She is right-handed. Mrs. M starts eating on her own, but she does not have the coordination in her left hand to manage the eating utensils to feed herself without great effort. Mrs. M tires easily and cannot complete eating the meal. The certified nursing assistant feeds her more than half of the meal. How do you code eating?
What is 02 Substantial/Maximal Assistance?
Mrs. N has early stage amyotrophic lateral sclerosis. She starts brushing her teeth and completes cleaning her upper teeth and part of her lower teeth when she becomes fatigued and asks the certified nursing assistant to help her finish the rest of the brushing. How do you code oral hygiene?
What is 03 Partial/Moderate Assistance? (Helper does less than half the effort)
Mrs. C has Parkinson’s disease and significant tremors and requires 2 staff members to transfer her to the toilet. She requires assistance with perineal hygiene and clothing management. Helper does more than half. How do you code toileting hygiene?
What is 02 Substantial/Maximal Assistance? (Toilet transfer is not included in Toileting Hygiene)
Mr. A suffered multiple vertebral fractures due to a fall off a ladder. He requires assistance from a therapist to get from a sitting position to lying flat on the bed because of significant pain in his lower back. The therapist supports his trunk and lifts both legs to assist Mr. A from sitting at the side of the bed to lying flat on the bed. Mr. A assists himself a small amount by raising one leg onto the bed and then bending both knees while transitioning into a lying position. How do you code Sit to Lying?
What is 02 Substantial/Maximal Assistance?
Mrs. P is recovering from Guillain-Barre Syndrome with residual lower body weakness. The physical therapist supports Mrs. P’s trunk as she gets to a fully upright sitting position on the bed and Mrs. P then lifts each leg toward the edge of the bed. Mrs. P then scoots toward the edge of the bed and places both feet flat on the floor. Mrs. P completes most of the effort to get from lying to sitting on the side of the bed. How do you code Lying to Sitting?
What is 03 Partial/Moderate Assistance? ("supports trunk" is less than half of the activity)
Mrs. C was admitted with a right ankle fracture with orders for non-weight bearing right LE. During your assessment you ask Mrs. C to move sit-to-stand. She puts all her weight on her left leg when attempting to stand but it unable to come to a standing position without maximal assistance from the physical therapist. How do code sit to stand?
What is 02 Substantial/Maximal Assistance?
Mr. M was transferred wheelchair to bed with less than half the effort completed by the helper. Mr. M then required maximal assistance to lift his legs onto the bed. How do you code Chair/Bed Transfer?
What is 03 Partial/Moderate Assistance? (Lifting legs onto the bed is included in GG item Sit to Lying)
Mr. G has a urinary catheter and requires total assistance to manage it. He transferred to the commode for a bowel movement and required minimal assistance. How do you code toilet transfer?
What is 03 Partial/Moderate Assistance? (Catheter management is not included in toilet transfer. Minimal assistance would be considered partial)
Ms. W has COPD with compromised respiratory status and walks very slowly. She requires minimal assistance to walk 25 feet, turn around and walk back 25 feet before sitting. How do you code walk 50 feet?
What is 03 Partial/Moderate Assistance? (50 feet does not have to be in a straight line, you need two 90 degree turns, same or different direction, 2 turns can be achieved in a full 180 degree turn)
On day of admission, Mr. J is assessed by PT for walking. He is able to walk 50 feet with 2 turns with minimal assistance and a rolling walker. The PT attempts to have Mr. J walk 150 feet but he refuses saying he is too tired. On day two of admission, the PTA begins the therapy session. Mr. J demonstrates the ability to walk 160 feet with minimal assistance and a rolling walker. How is walk 150 feet coded on day 2?
What is 03, Partial/Moderate Assistance? (Don't forget CMS gives you 3 days to assess walking, it's important to utilize day 2 or 3 when the resident cannot perform the task on day one)