FIND A CLINIC

7 Fun Ways to Remember Critical PDPM Coding Success Tips

by Blue Sky Therapy
0 Comments

It's October 1st and we hope you are ready.   These 8 rhyming lines will help keep your ship steady.

Blue Sky Therapy wants to help you succeed.  We think these reminders will be something you need.

 

  • 1. CODING ACCURACY ACROSS THE BOARD IS KEY.  LOTS OF INFO EARLY WILL HELP ME SUCCEED!

    • A great way to ensure accuracy is to start early.  By screening pre-admission you can get an idea of what sort of documentation is coming in with the new resident and that will set you up for success to have consistent ICD-10-CM coding in all areas (Medical Record, MDS, claim, etc.). 
  • 2. RIGHT OR LEFT, THEY NEED TO KNOW!  OR OUT THE WINDOW REIMBURSEMENT WILL GO!

    • Specificity will be your friend under PDPM.  Many "vague" diagnoses are coming back as Return To Provider (RTP) codes.  One example is Unspecified Laterality for Hip Fractures, hence the rhyme! 
  • 3. DARN! THAT CODE IS RETURN TO PROVIDER.. AH, BUT WAIT! IT CAN STILL BE USED TO DESCRIBE HER!
    • Just because a condition is a non-viable I0020B code as the principal diagnosis does not mean we cannot use it to describe a resident.  E.g.  Resident is skilled for right hip fracture and also has documented hypertension.  Be sure to include hypertension in Section I.   
  • 4. NTAs, SO MANY TO CHOOSE, LETS LOOK BACK A WEEK AND SEE WHAT TO USE!
    • These 50 conditions will be derived from a key ICD-10 code and will help identify NTA points which will critically impact both care delivery and reimbursement.  It is important to have strong processes in place for accurately reporting NTA conditions as well as speech-related comorbidities.  It would be smart to have processes in place to review comorbidities and resident needs PRIOR to admission.  Don't forget the documentation required in the 7-day look back window to justify the NTA.
  • 5. THE LAST 7 DAYS ARE THE MOST IMPORTANT.  LET'S LOOK BACK 2 MONTHS TO SEE WHAT WAS REPORTED!
    • Current status must be documented by a provider (Physician, Nurse Practitioner, Physician Assistant, Clinical Nurse Specialist) in the last 60 days AND be determined ACTIVE (has a direct relationship to the resident's current status in the last 7 days [except UTI which has a 30 day look back period]).
  • 6. ANOTHER NEW FACE IN OUR FACILITY, LET ME GO FIND THERAPY TO ADDRESS THEIR ABILITY!
    • PDPM and COLLABORATION go hand in hand.  Interdisciplinary communication and strong knowledge of new resident history will drive the most appropriate principal diagnosis.  A strong Rehab Care Manager collaborating with your MDS nurse, DON, and nursing staff will be a tremendous benefit to all.  Ensure everyone is on the same page and all is coded the same across the board.  Supporting documentation of all ICD-10-CM codes should be present throughout medical, nursing, and therapy documentation.  
  • 7. WHAT YOU SAY AND WHAT YOU DO MUST BE IN LINE THROUGH AND THROUGH.  IT MUST BE CHECKED AND CHECKED AGAIN.  THEN TRIPLE CHECKED AND THAT’S THE END!

    • Auditing processes are going to be a pillar of success under PDPM.  Who will do this to ensure appropriate documentation procedures are followed?  This will help make sure the conditions coded for each patient under PDPM are clearly indicated in the documentation and consistent throughout.  

 

 

  •  

 

  •  

  •  
  •  

 

News Blog Compliance Nursing Home Physical Therapy PDPM Skilled Nursing Facilities ICD-10 Documentation