GG Items (Functional Abilities)
GG items are the standardized functional ability items in Section GG of the OASIS, covering prior functioning, prior device use, self-care (GG0130), and mobility (GG0170). They score how much help a patient needs to complete everyday activities on a common 6-level scale used across home health, skilled nursing, inpatient rehab, and LTACH settings, and they feed federal quality measures.
How the GG scale works
Each GG activity is scored by how much assistance the patient needs to complete it safely:
- 06: Independent
- 05: Setup or clean-up assistance
- 04: Supervision or touching assistance
- 03: Partial/moderate assistance, helper does less than half the effort
- 02: Substantial/maximal assistance, helper does more than half the effort
- 01: Dependent, helper does all of the effort or two helpers are required
When an activity is not attempted, clinicians use the not-attempted codes instead, indicating refusal, non-applicability, environmental limitations, or medical/safety concerns. Scoring reflects the patient's usual performance during the assessment period, not their best or worst single attempt.
What GG items are used for
GG items exist because of the IMPACT Act, which required post-acute care settings to collect standardized data so CMS can compare patients and outcomes across settings. In home health they drive function-related measures in the Quality Reporting Program, including discharge function performance, and OASIS-based function measures carry real money under the expanded HHVBP model, where OASIS-based measures make up 40% of the Total Performance Score in CY2026, including new bathing and dressing function measures. Note the division of labor: GG items drive quality measurement, while the PDGM functional impairment level is still built from M1800-series responses.
GG vs. M1800 items: same patient, different rules
Clinicians score function twice on the same assessment, and the conventions differ. M1800-series items ask about the patient's ability to perform tasks safely, with response options specific to each item. GG items ask how much assistance the patient needs, on the uniform 6-level scale, based on usual performance. A patient can legitimately land on scores that look different across the two sections, but the overall functional picture must be clinically coherent. QA reviewers and auditors flag records where GG says substantial assistance and the M items say independent, or vice versa, without narrative support.
Getting GG scoring right in the field
Accurate GG scoring is observational. Have the patient actually perform the activity when safe: walk the distance, don the shirt, get up from the chair. Score usual performance across the assessment timeframe rather than a single best effort, and resist the urge to score what the patient could probably do. Use not-attempted codes honestly instead of guessing. Document what you observed, because the note is what defends the score in an ADR or survey. And when admission scores are inflated, remember the discharge comparison will show no improvement, hurting measured outcomes.
Frequently asked questions
Do GG items affect PDGM payment?
Not directly. The PDGM functional impairment level comes from M1800-series items and M1033. GG items drive quality measures, which affect payment indirectly through HHVBP adjustments of up to plus or minus 5% and through publicly reported performance.
What does scoring usual performance mean?
The score should reflect how the patient typically completes the activity over the assessment period, not their single best or worst attempt. If performance varies, clinicians score the usual level of assistance needed, and document the variability.
When should a not-attempted code be used?
When the activity genuinely was not attempted during the assessment timeframe, coded by reason: patient refusal, not applicable, environmental limitation, or not attempted due to medical condition or safety concerns. Not-attempted codes should reflect reality, not scoring convenience, since they affect measure calculations.