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We have a new Part A skilled admission who was treated for dehydration, weakness, and nausea during qualifying hospital stay. There are no other diagnosis requiring treatment noted in the hospital documentation. All of these diagnosis map to Return to Provider (RTP). What should we do in this situation?
You are required to have a diagnosis code that maps to a PDPM Clinical Category as the Primary diagnosis at I0020B. I recommend that you discuss the reason for the skilled stay with the resident’s provider to determine if there is a medical diagnosis associated with the symptoms of dehydration, weakness, or nausea that would be appropriate as the Primary diagnosis. If not, you will not be able to access this patients Medicare benefit if there is no primary diagnosis present that maps to a clinical category. This is why it is so important to complete a Pre-Admission evaluation prior to admission to determine if a residents meets the requirements for skilled care and has an appropriate diagnosis that maps to a PDPM Clinical Category. Proactive’s Pre-Admission Screen and Pre-Admission Interview tool kit is a resource available that guides the SNF admissions team in gathering essential information for estimating care needs and identifying critical factors impacting the PDPM per diem rate, such as the Primary diagnosis.
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Blog by Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Proactive Medical Review
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