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DiraChart MDS item reference
GG0115ASection GGv1.20.1Manual page GG-5
ROM limitation: upper extremity
This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.
Quick coding
Answer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Coded response
1
impairment on one side
Manual page GG-52
impairment on both sides
Manual page GG-5Item-specific instructions
Coding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
Steps for Assessment
1. Review the medical record for references to functional range-of-motion limitation during the
7-day observation period.
2. Talk with staff members who work with the resident as well as family/significant others
about any impairment in functional ROM.
3. Coding for functional ROM limitations is a three-step process:
•
Test the resident’s upper and lower extremity ROM (See item 6 below for
Coding Instructions
for GG0115A, Upper Extremity (Shoulder, Elbow,
Wrist, Hand); GG0115B, Lower Extremity (Hip, Knee, Ankle,
Foot)
•
Code 0, no impairment: if resident has full functional range of motion on the right
and left side of upper/lower extremities.
•
Code 1, impairment on one side: if resident has an upper- and/or lower-extremity
impairment on one side that interferes with daily functioning or places the resident at risk
of injury.
•
Code 2, impairment on both sides: if resident has an upper- and/or lower-
extremity impairment on both sides that interferes with daily functioning or places the
resident at risk of injury.
Coding Tips
•
Do not look at limited ROM in isolation. You must determine whether the limited ROM
has an impact on functional ability or places the resident at risk for injury. For example, if
the resident has an amputation, it does not automatically mean that they are limited in
function. A resident with an amputation may not have a particular joint in which a certain
range of motion can be tested, however, that does not mean that the resident necessarily
has a limitation in completing activities of daily living, nor does it mean that the resident
is automatically at risk of injury. There are many amputees who function extremely well
and can complete all activities of daily living either with or without the use of prosthetics.
If a resident with an amputation does indeed have difficulty completing ADLs and is at
risk for injury, the facility should code this item as appropriate. This item is coded in
terms of function and risk of injury, not by diagnosis or lack of a limb or digit.
GG0115: Functional Limitation in Range of Motion (cont.)
Coding Instructions for GG0115A, Upper Extremity (Shoulder, Elbow,
Wrist, Hand); GG0115B, Lower Extremity (Hip, Knee, Ankle,
Foot)
•
Code 0, no impairment: if resident has full functional range of motion on the right
and left side of upper/lower extremities.
•
Code 1, impairment on one side: if resident has an upper- and/or lower-extremity
impairment on one side that interferes with daily functioning or places the resident at risk
of injury.
•
Code 2, impairment on both sides: if resident has an upper- and/or lower-
extremity impairment on both sides that interferes with daily functioning or places the
resident at risk of injury.
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