ICD.10 coding will have a major impact under PDPM

ICD.10 coding will have a major impact under PDPM with the PT, OT, SLP and the bulk of the NTA items (35 of the 50 are diagnosis related items) paid in part based on the diagnoses coded on the MDS.

You’ve attended training on ICD.10, now what? Follow these tips to build your team’s confidence as you prepare for 10/1:

  • If your software does not yet have a PDPM estimator, use the Clinical Category mapping tool on the CMS website to determine where current Medicare admissions will fall under PDPM
  • Watch for codes that are “Return to Provider” under PDPM which means after 10/1 those codes will not be accepted as the primary reason for the SNF stay. “Return to Provider” status under PDPM is based on the code selected not supporting a skilled stay, or the code being too vague or ill-defined (e.g. missing laterality of a fracture.)
  • Develop coding trainers in your facility that may serve as coaches to the team. Conduct follow-up audits of coding post-training to ensure application of learning and identify process gaps.
  • Update clinical meeting processes and procedures to incorporate coding discussions.

Check out Proactive’s coding tools and trainings and contact Proactive for information on PDPM audit partner services.

Proactive Coding Tools

Click here for: Moving Mountains Series: PDPM – Developing ICD-10 Expertise for Effective Coding of Clinical Categories & Non-Therapy Ancillary Webinar.

Click here for: All PDPM Tools.

Click here for: PDPM Triple Check Process Toolkit for Billing Accuracy.

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Blog by Amie Martin OTR/L, CHC, RAC-CT, President, Proactive Medical Review

Click here to learn more about Amie and the rest of the Proactive team.