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PDPM Coding Questions – How should isolation be coded on the MDS since there is guidance to restrict movement around the facility as part of the COVID-19 prevention plan?
Q: How should isolation be coded on the MDS since there is guidance to restrict movement around the facility as part of the COVID-19 prevention plan? A: You cannot code isolation on the MDS if it is only in place to prevent contracting the COVID 19...
Critical Action Steps for LTC Facilities’ COVID-19 Response
As of a March 23 report by CMS, at least 147 nursing homes across 27 states have at least one resident with COVID-19. As we work to protect our residents and staff in response to the risk of COVID-19 infection, providers are encouraged to consider these action items...
Coding Isolation on MDS
The RAI Manual provides clear instruction on the coding of isolation. Documentation must support the medical necessity of isolation. Per the MDS 3.0 RAI User’s Manual, Isolation is coded only when: The resident requires transmission-based precautions AND Single room...
COVID-19 CDC Nursing Home Guidance and Managing Suspected Cases
Residents of long-term care facilities are at the highest risk of being affected by COVID-19 because of advanced age and chronic medical conditions and co-morbidities. Not only are they at higher risk but have an increased risk of critical illness. Also, there are...
How do we code Coronavirus (COVID-19) on the MDS?
COVID-19 ICD-10-CM Effective April 1 On 3/18/20, the Centers for Disease Control and Prevention (CDC) announced that the effective date of a new diagnosis code U07.1, COVID-19, from October 1, 2020 to April 1, 2020. According to the CDC, “this off-cycle update is...
COVID-19 Considerations for IPA Completion
The Interim Payment Assessment (IPA) is an optional assessment that may be completed to capture changes in a resident’s status and condition and to report a change in a patient’s PDPM classification. Providers determine when to complete an IPA, which may be any time...
PDPM Coding Question – How should situations, in which the 3-day qualifying hospital stay normally required for a covered Medicare admission to the SNF is waived due to the national emergency, be reported on the UB04 claim form?
Q: How should situations, in which the 3-day qualifying hospital stay normally required for a covered Medicare admission to the SNF is waived due to the national emergency, be reported on the UB04 claim form? A: Providers that receive beneficiaries without a...
National Emergency Declaration: Quick Summary of Medicare Impact
With the growing concern surrounding Coronavirus (COVID-19) and the slew of emails you’re likely receiving, we want to provide you with a brief, focused summary of how this pandemic has temporarily changed our current practices and regulations surrounding our Medicare...
PDPM Coding Questions – If a resident has a BMI greater than 40 but the MD has not documented “morbid obesity”, can we enter the Z code for BMI in the MDS and receive the NTA point?
Q: If a resident has a BMI greater than 40 but the MD has not documented “morbid obesity”, can we enter the Z code for BMI in the MDS and receive the NTA point? A: Yes, but as stated in the ICD-10-CM Code Book: BMI codes should only be assigned when the...
PDPM Coding Questions – If the dietitian completed a malnutrition assessment and the score indicates “at risk for malnutrition”, is the assessment considered sufficient supportive documentation to code Malnutrition in Section I if the physician were to review and sign the assessment form?
Q: If the dietitian completed a malnutrition assessment and the score indicates “at risk for malnutrition”, is the assessment considered sufficient supportive documentation to code Malnutrition in Section I if the physician were to review and sign the assessment form?...
PDPM Coding Questions – Can you capture the respiratory therapy reimbursement if the nebulizer is being administered by a nurse?
Q: Can you capture the respiratory therapy reimbursement if the nebulizer is being administered by a nurse? A: Yes, as long as the nurse is proficient in the modalities. RAI Appendix A defines Respiratory Therapy as: Services that are provided by a qualified...
PDPM Medical Review Preparation: Tips for Assessing Data & Documentation
Most facilities have fared better than anticipated under Patient-Driven Payment Model (PDPM). What will this mean from the standpoint of Medicare claims audits and how should we prepare for the inevitable start of medical review activity for PDPM claims? For many...
PDPM Coding Questions – The physician documented dehydration on the discharge summary, however the resident does not qualify for any of the 3 items listed in the RAI manual in J1550. Should dehydration be coded on the MDS?
Q: The physician documented dehydration on the discharge summary, however, the resident does not qualify for any of the 3 items listed in the RAI manual in J1550. Should dehydration be coded on the MDS? A: The coding for dehydration is based on the presence of...
Restorative Nursing Under PDPM – Part 2
The QM, Functional Outcome & Reimbursement Perks of Restorative Nursing Restorative & PDPM As we began discussing in part 1 of this blog last week, there are many benefits to considering Restorative Nursing programs. In part 2 of this blog, let’s review some...
Upcoming Five Star Insights: Achieve 5 Star in 2020 Webinar Series
This 10-part webinar series will focus on mastering the three domains of the CMS 5-Star Quality Rating System: Health Inspections, Staffing, and Quality Measures. You will learn how to analyze your data and develop a results-oriented action plan to achieve 5-Star...