86880-2 Activities of Daily Living (ADL) Assistance. Self-Performance

Observation ID in Form

G0110_1

Form Coding Instructions

Refer to the ADL flow chart in the RAI manual to facilitate accurate coding. Instructions for Rule of 3: When an activity occurs three times at any one given level, code that level. When an activity occurs three times at multiple levels, code the most dependent, exceptions are total dependence (4), activity must require full assist every time, and activity did not occur (8), activity must not have occurred at all. Example, three times extensive assistance (3) and three times limited assistance (2), code extensive assistance (3). When an activity occurs at various levels, but not three times at any given level, apply the following: When there is a combination of full staff performance, and extensive assistance, code extensive assistance. When there is a combination of full staff performance, weight bearing assistance and/or non-weight bearing assistance code limited assistance (2). If none of the above are met, code supervision

Form Coding Instructions

Code for resident's performance over all shifts - not including setup. If the ADL activity occurred 3 or more times at various levels of assistance, code the most dependent - except for total dependence, which requires full staff performance every time

Fully-Specified Name

Component

MDS v3.0 - RAI v1.17.2 - Activities of daily living (ADL) assistance - self-performance

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.63

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with panel children and based on the new model for representing a range of reporting periods (e.g. 3 day, 7 day, etc.) across CMS assessments.; Release 2.68: COMPONENT: Assessment version number was updated to reflect the most recent version.; Previous Releases: This panel is in version 1.14.1, 1.15.1, and 1.16.1. So "v1.16.1" was added to the Component; Current convention (as approved by the joint CMS LTPAC & LOINC project team) will list only the most current assessment in the Component for CMS Assessment panels.

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Activities of Daily Living
• ADL assistance
• Centers for Medicare and Medicaid Assessment
• Pan
• Panel
• PANEL.SURVEY.CMS
• Panl
• Pnl
• Report period
• Survey

Related Codes

45588-1 Bed mobility

Observation ID in Form

G0110A1

Form Context

How resident moves to and from lying position, turns side to side, and positions body while in bed or alternate sleep furniture

Fully-Specified Name

Component

Bed mobility - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; COMPONENT: Removed "7D"; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45590-7 Transfer

Observation ID in Form

G0110B1

Form Context

How resident moves between surfaces including to or from: bed, chair, wheelchair, standing position (excludes to/from bath/toilet)

Fully-Specified Name

Component

Transfer - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: COMPONENT: Removed "7D"; TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45592-3 Walk in room

Observation ID in Form

G0110C1

Form Context

How resident walks between locations in his/her room

Fully-Specified Name

Component

Walk in room - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; COMPONENT: Removed "7D"; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45594-9 Walk in corridor

Observation ID in Form

G0110D1

Form Context

How resident walks in corridor on unit

Fully-Specified Name

Component

Walk in corridor - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; COMPONENT: Removed "7D"; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINCcommittee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45596-4 Locomotion on unit

Observation ID in Form

G0110E1

Form Context

How resident moves between locations in his/her room and adjacent corridor on same floor. If in wheelchair, self-sufficiency once in chair

Fully-Specified Name

Component

Locomotion on unit - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: COMPONENT: Removed "7D"; TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45598-0 Locomotion off unit

Observation ID in Form

G0110F1

Form Context

How resident moves to and returns from off-unit locations (e.g., areas set aside for dining, activities or treatments). If facility has only one floor, how resident moves to and from distant areas on the floor. If in wheelchair, self-sufficiency once in chair

Fully-Specified Name

Component

Locomotion off unit - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; COMPONENT: Removed "7D"; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45600-4 Dressing

Observation ID in Form

G0110G1

Form Context

How resident puts on, fastens and takes off all items of clothing, including donning/removing a prosthesis or TED hose. Dressing includes putting on and changing pajamas and housedresses

Fully-Specified Name

Component

Dressing - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; COMPONENT: Removed "7D"; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINCcommittee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45602-0 Eating

Observation ID in Form

G0110H1

Form Context

How resident eats and drinks, regardless of skill. Do not include eating/drinking during medication pass. Includes intake of nourishment by other means (e.g., tube feeding, total parenteral nutrition, IV fluids administered for nutrition or hydration)

Fully-Specified Name

Component

Eating - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; COMPONENT: Removed "7D"; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45604-6 Toilet use

Observation ID in Form

G0110I1

Form Context

How resident uses the toilet room, commode, bedpan, or urinal; transfers on/off toilet; cleanses self after elimination; changes pad; manages ostomy or catheter; and adjusts clothes. Do not include emptying of bedpan, urinal, bedside commode, catheter bag or ostomy bag

Fully-Specified Name

Component

Toilet use - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: COMPONENT: Removed "7D"; TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

45606-1 Personal hygiene

Observation ID in Form

G0110J1

Form Context

How resident maintains personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face and hands (excludes baths and showers)

Fully-Specified Name

Component

Personal hygiene - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: COMPONENT: Removed "7D"; TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL850-9

Member of these Panels

Related Names

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

Related Codes

86887-7 Bathing

Observation ID in Form

G0120

Form Coding Instructions

How resident takes full-body bath/shower, sponge bath, and transfers in/out of tub/shower (excludes washing of back and hair). Code for most dependent in self-performance and support

Fully-Specified Name

Component

MDS v3.0 - RAI v1.17.2 - Bathing - ND, SD

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.63

Last Updated

Version 2.70

Change Reason

Release 2.70: TIME_ASPCT: Updated Timing to align with panel children and based on the new model for representing a range of reporting periods (e.g. 3 day, 7 day, etc.) across CMS assessments.; Release 2.68: COMPONENT: Assessment version number was updated to reflect the most recent version.; Previous Releases: This panel is in version 1.14.1, 1.15.1, and 1.16.1. So "v1.16.1" was added to the Component; Current convention (as approved by the joint CMS LTPAC & LOINC project team) will list only the most current assessment in the Component for CMS Assessment panels.

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

45608-7 Self-performance

Observation ID in Form

G0120A

Fully-Specified Name

Component

Bathing - self-performance during assessment period

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: COMPONENT: Removed "7D"; TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing answer list supports that the Timing should have been 7D when the term was created. Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS

Order vs. Observation

Observation

Normative Answer List LL27-4

Member of these Panels

Related Names

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

Related Codes