CMS issued corrections to the FY 2024 SNF PPS Final Rule PDPM ICD-10 Mapping. The document, which was issued and effective April 10, 2024, makes corrections to technical errors that are applicable beginning 10/1/2023. This correction document can be accessed at the link below:
The correction included in this documentation include corrections to technical errors in clinical mapping for a subset of codes. CMS indicated it was their intent to add the surgical option that allows a subset of subcategory 42.2—codes for displaced fractures to be eligible for one of two orthopedic surgery categories. CMS further indicated the surgical option would be added to the subcategory of M84.5—codes for pathological fractures to certain weight bearing bones to be eligible for one of two orthopedic surgery categories. When the final rule was published, CMS inadvertently stated that this proposal applied to 45 of the codes within the subcategory S42.2 codes and to 46 of the codes within the subcategory M84.5 codes. However, these numbers were inadvertently swapped, meaning that the proposal applied to 46 of the codes within the subcategory S42.2 codes and to 45 of the codes within the subcategory M84.5 codes. We are correcting these errors.
In addition to the technical error noted above, CMS is correcting errors in the clinical category assignment for the following two codes:
- B99.8 (Other infectious disease) and
- B99.9 (Unspecified infectious disease)
Since no changes were addressed related to the Medical Management clinical category assignment of these codes, a correction was made to reinstate the clinical category to medical management for these codes.
The corrected clinical mapping file can be found at the following link: https://www.cms.gov/medicare/medicare-fee-for-service-payment/snfpps/pdpm
Providers should contact their software vendor to validate that the system has been updated with the corrected mapping files and verify whether any corrected billing may be indicated as a result of the modifications.
Written by Christine Twombly, RN-BC, RAC-MT, RAC-MTA, HCRM, CHC
Clinical Consultant
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