Blue Sky Therapy Blog

The Shot Clock is Ticking… Get in the PDPM Coding Game!

by Rachel Brainard

Preparing for PDPM seems like a massive undertaking – and it is! - but there are steps you can take today to prepare to reduce the impact of the transition.

As you are likely aware, the new PDPM model appears less focused on the number of therapy minutes spent with residents and more focused on residents’ clinical characteristics. Even so, the minutes are required to be reported with the expectation that the appropriate level of therapy will still be provided. ICD-10 diagnosis codes that will be used to place the resident into one of 10 PDPM clinical categories will impact the payment components for physical therapy (PT), occupational therapy (OT), speech therapy, and nursing skilled services, as well as non-therapy ancillary (NTA) costs.

When these changes take effect in October 2019, providers will have a single opportunity to set themselves up for financial success with a patient’s initial assessment. All reimbursements will be based on a patient’s initial assessment for the duration of his or her stay in a skilled nursing facility, with further revisions not having a significant impact in the amount of money that a provider can capture for the course of the episode.

This could prove difficult for nursing home staffers who are more accustomed to assessing a patient through the lens of the old Resource Utilization Group, Version IV (RUG-IV) model and not necessarily his or her specific diagnoses.

So how can you thrive through this transition? It is time to up your ICD-10 coding game!

Providers should start to identify and perhaps incentivize an individual in each facility to attain a professional coding designation available through the American Academy of Professional Coders (AAPC). While CMS did not specify a continuing education program that’s most closely aligned with PDPM, the CIC certification focuses on critical ICD-10 codes used in both skilled nursing facilities and hospitals. The credentialing process can take upwards of nine months, the consultancy cautioned, so operators need to act soon in order to have certified coders on staff when PDPM takes effect.

We know the PDPM change is looming overhead and it comes with many confusing updates, but now is the time for you and your staff to prepare.


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