Blue Sky Therapy Blog

New PDPM ICD-10 Diagnosis Codes For SNFs

by Blue Sky Therapy

By: Lisa Chambers, MSCCC-SLP, CHC


Over the last month, there has been concern that the ICD-10 diagnosis codes identified by the CDC as appropriate to code for COVID-19 were not compatible with Medicare’s Patient-Driven Payment Model (PDPM).


Effective April 1, 2020, CMS has instituted new FY2020 PDPM ICD-10 Mappings to reflect updates of the new diagnosis codes related to COVID-19.


The new COVID-19 code (U08.1 – 2019-nCOV acute respiratory disease) if entered will map to the PDPM 'Pulmonary' default clinical category used for the PT, OT, and SLP components. The updates are effective for assessments as of April 1, 2020. For assessments with dates before March 31, 2020 or earlier, providers should enter the most appropriate ICD-10 code available in the I0020B item field. 


Of note: This new code does not impact the PDPM Nursing or NTA component classifications at present even though the clinical characteristics and associated services related to a COVID-19 patient will influence nursing capture.


Additional information is located on the CMS MDS 3.0 Technical Information site. There are several diagnosis code examples listed regarding COVID-19. Some of the new diagnosis codes map to RTP instead of a clinical category which cannot be used for primary diagnosis.


Providers should be checking with their software vendors to confirm that these codes have been updated.


If you need additional support on the updated codes or PDPM in general, you can reach out to us here. We also have several educational pieces about PDPM that can be found on our website under PDPM. Click here to access that information.

PDPM ICD-10 covid-19 covid-19 updates icd-10 coding updates new pdpm icd-10 codes for covid-19 billing updates for covid-19 covid-19 updates for nursing homes

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