For Skilled Nursing Facilities (SNFs) to receive proper and timely reimbursement after the shift to the upcoming Patient Driven Payment Method (PDPM), accurate ICD-10-CM diagnosis codes are going to be essential. Knowing which code to use can be confusing, especially when the resident has recently had a surgical procedure. That’s why we’ve created our newest PDPM asset, “Steps to Clinical Mapping under PDPM.”
If a resident had a specific, related surgical procedure performed in the hospital immediately preceding their admission to the skilled nursing facility, the resident could be eligible for a surgical ICD-10 code.
There are three surgical clinical categories where this may occur; major joint replacement or spinal surgery, orthopedic surgery (except major joint replacement and spinal surgery) and non-orthopedic surgery. The surgical procedure code lists provided will be used as a reference by the skilled nursing facility staff to augment the resident’s clinical category classification. The staff would review the information sent by the preceding hospital stay to identify any procedures defined in these surgical clinical categories. This process is further discussed in the FY 2019 SNF PPS NPRM.
We know PDPM will be a big shift, that’s why we’ve created this mapping infographic and an entire PDPM Resource Center to house assets like the, “Steps to Clinical Mappin Under PDPM,” shown here and so much more!