PDPM: ICD-10-CM Information for Your SNF

The Patient Driven Payment Model may be a new case-mix classification system that may replace the Resource Utilization Group, Version IV (RUG-IV), effective October 1, 2019. The PDPM can classify skilled nursing facility (SNF) patients in a very medicare part A stay into payment teams as part of the SNF Prospective Payment System. RUG IV primarily uses medical aid service volume as the basis for payment. The declared intent of PDPM is to classify patients into payment groups based mostly on patient characteristics and conditions.

Report the Primary Diagnosis for the SNF Stay

Under PDPM, suppliers can report on the Minimum Data Set (MDS) the patient’s primary diagnosis for the SNF stay. The FAQs state that CMS expects the principal diagnosing on the SNF claim to match the primary diagnosis in item I0020B, the new item being added to the MDS beneath PDDM as a space for the patient’s primary SNF diagnosis. however there won’t be a claims edit to enforce that match.

CMS has mapped every primary diagnosis to a PDPM clinical class. the 10 PDPM clinical categories each represent teams of similar diagnosis codes. The categories play a task in the patient’s classification under the physical therapy(PT), occupational therapy (OT), and speech-language pathology (SLP) components (these are 3 of the 5 case-mix adjusted components, at the side of a non-therapy ancillary services component and a nursing component).

Select Additional Diagnoses to Show Bigger Picture

You’ll conjointly use ICD-10-CM codes to capture further diagnoses and comorbidities because these may affect patient classification beneath the SLP component and also the non-therapy ancillary (NTA) comorbidity score.

CMS can use the NTA comorbidity score to classify the patient into an NTA component payment cluster. Comorbidities connected to higher NTA costs have higher points. The score is the sum of the points related to each comorbidity. Check section 3.3 of the FAQs to visualize the comorbidities used beneath the NTA component. As an example, lung Transplant status is assigned 3 points and the source is MDS Item I8000.

What Can You Do to Get Your SNF ICD-10-CM Ready?

Remember when ICD-10 replaced ICD-9? just like that massive transition, the present modification needs preparation for the complete team.

• Train clinicians and everybody involved with the MDS, code assignment, and compensation on how to locate ICD-10-CM codes and therefore the importance of selecting complete, correct codes based on the documentation.
• To speed the method of pinpointing codes, consider obtaining SNF ICD-10-CM cheat sheets that you will place in convenient locations.
• Review the “PDPM ICD-10 Mappings” file offered at that same CMS PDPM web site coupled in the summary section above. Look below PDPM Resources close to all-time low of that page to access the file, that contains the ICD-10-CM to Clinical category Mapping, SLP Comorbidity to ICD-10-CM Mapping, and NTA Comorbidity to ICD-10-CM Mapping.