![]() A trend of questionable, potential ICD-10 Coding errors on SNF claims, such as incorrect 7 th characters, can trigger scrutiny and Additional Documentation Requests from CMS. The Health Insurance Portability and Accountability Act (HIPAA) mandates that all healthcare entities adhere to official coding guidelines. The first step is to become familiar with all the Official Coding Guidelines that are available at and usually in the front of ICD-10 Coding manuals. It is not easy to identify and select the most specific, accurate code. It is essential that they understand or can access basic coding guidelines easily and are comfortable using an ICD-10 Coding manual. MDS Nurses do not need to be expert coders, but they must be able to connect the dots between the diagnoses and the rationale for skilled care. ICD-10-CM Codes capture a resident’s clinical conditions to support services billed for Medicare Part B in addition to Managed Care and Medicare Part A. ![]() Hence, it is imperative to identify and properly document the correct ICD-10 Codes that best reflect the patient’s reason for Skilled Medicare Coverage upon admission to the SNF. As the name states, the Patient Driven Payment Model (PDPM) compensates by patient characteristics and the associated ICD-10 Codes. (HHI) recommends that an FY 2020 ICD-10-CM Code book be available for the MDS Coordinator to access all other current codes. Providers should check with their software vendors to confirm when the update for this change has been applied. It does not currently impact either the PDPM Nursing or the NTA component. For Minimum Data Set (MDS) assessments with an Assessment Reference Date (ARD) of April 1, 2020, or later, this code, U07.1, maps to the PDPM Pulmonary clinical category for the PT, OT and SLP components. The Centers for Medicare & Medicaid Services (CMS) has posted an updated FY 2020 PDPM Mappings file that includes the ICD-10 CMS code “U07.1 – 2019-nCoV acute respiratory disease” as an appropriate code for MDS item I0020B, the primary reason for the skilled nursing facility (SNF) stay. The Index and Tabular Addenda and the Coding Guidelines for the new diagnosis code U07.1, COVID-19, can be accessed on the CDC website at. The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is adding a new diagnosis code, U07.1, COVID-19, to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective April 1, 2020. ACDIS coverage of new CPT codes relating to COVID-19 can be found here. The CDC announcement of the new codes can be found here. Full addenda information regarding the new codes is available here.Įditor’s note: This article originally appeared in Revenue Cycle Advisor.
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