Thursday, October 3, 2019

Your Top-Line PDPM Special Issue

On October 1, a new payment model, the Patient Driven Payment Model (PDPM), went into effect, replacing the long-standing RUGs system for reimbursement of Part A Medicare FFS claims under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). The SNF benefit has not changed, but the way patients are classified for payment has changed substantially. One of the biggest changes and an important component of success under PDPM, is the role of ICD-10 coding.
To help our members better understand their ICD-10 coding practices, we have produced a PDPM Special Issue of Your Top-Line  available on LTC Trend Tracker. This special issue uses ICD-10 codes from your 2018 MDS assessments to show how your past coding practices would translate to case-mix categories under PDPM.
How do I use this publication?
ICD-10 coding will be more important now than it has ever been for SNFs. This resource is meant to provide a snapshot of how you have been coding ICD-10 fields on your MDS in the past. Do not worry if you have codes that do not map to PDPM on this report since that was not part of the system in place. Under PDPM, the primary reason for Part A FFS Medicare admissions will be the only ICD-10 code that needs to map to a PDPM category. The other codes you are using are still valid as comorbidities in the I8000 fields and may also be appropriate for non-Part A FFS Medicare patients as a reason for admission.
This snapshot will prepare you to think about what alternative ICD-10 coding practices your clinical team needs to come up with when filling out the 5-day PPS Assessment to ensure you do not leave money on the table. It helps you establish a baseline for not only ICD-10 coding practices, but also for a number of other elements of the MDS we anticipate CMS will monitor to see if and how providers are changing their behavior.
The figures included in the report also give you a sense of what base clinical categories your patients fall into under PDPM and how many SLP and NTA comorbidities you are capturing in your coding practices at this time.
If you are not feeling confident about your ability to correctly code ICD-10 under PDPM, AHCA has made many resources available to help you. These resources are listed below.
Click here to access the Your-Top Line: PDPM Special Issue Frequently Asked Questions document.

Click here to log in to LTC Trend Tracker to download this publication.
Click here to download the complete list of ICD-10 codes used in your building in 2018. Descriptions of all codes and whether they would require surgical modifiers or qualify as SLP or NTA comorbidities is also indicated.
Resources from AHCA:
Resources from CMS:
For additional questions about PDPM, please email

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