Wednesday, August 28, 2019

CMS Posts Updated Final List of Acceptable ICD-10 Codes for PDPM Primary Reason for SNF Stay MDS Item I0020B

Dan Ciolek

The new Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) called the Patient Driven Payment Model (PDPM) will cover all resident days starting on October 1, 2019.  PDPM requires an acceptable ICD-10 diagnosis code to be entered into MDS item field I0020B to represent the primary reason for the SNF stay.  ICD-10 codes not on the list of allowable codes, often referred to as “return-to-provider” codes, will not classify into a PDPM clinical category.  CMS publishes a list ICD-10 codes that are approved for use in MDS Item field I0020B for PDPM classification purposes.  The file includes the following information: 1) Alphanumeric ICD-10 code; 2) Code Description; 3) Default Clinical Category; 4) Whether a MDS Section J Surgery Code Indicating That the Resident Had a Prior Major Surgical Procedure is Needed to Refine the Default Clinical Category; 5) PT and OT Component Clinical Category; and 6) SLP Component Clinical Category.  If a code is not listed in this file, it cannot be used in the MDS I0020B item field.  CMS published an updated list on August 20, 2019.  CMS provides this file in a Microsoft Access Format.  AHCA converted the CMS file into Microsoft Excel for providers that are not familiar with Microsoft Access.  Both files can be accessed from ahcancalED HERE.   The CMS webpage file, can be found HERE.  The CMS webpage also includes the final version of the October 1 implementation MDS 3.0 Data Specifications (V3.00.1) for software developer use.   

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