McKnight’s Articles

Copernicus update! The Earth now revolves around ICD-10 codes

Until the early 1500s, virtually everyone held the truth that the Earth was the center of the universe. Then the Polish scientist Nicolaus Copernicus proposed that the planets actually revolve around the sun, a fact that we live by today.

In the past, our skilled nursing world has revolved around a sun of its own, known as resource utilization groups (particularly the lucrative high-therapy ones). Now, however, according to the details of the new Medicare fee-for-service reimbursement model known as the Patient Driven Payment Model (PDPM), it seems that we’ll soon be revolving around a different sun altogether: ICD-10 codes.

For SNF providers, this means that the old ways of doing business, or at least documenting resident assessments on the MDS, won’t work under the new model. One of the most significant changes is the promotion of diagnoses to be key drivers for reimbursement under PDPM.  Beginning October 1, 2019, diagnoses (specifically ICD-10 codes) will be used to place the resident into one of 10 PDPM clinical categories which will determine the payment components for physical therapy (PT)/occupational therapy (OT), speech, and nursing skilled services, as well as non-therapy ancillary (NTA) costs.

While this new model will deliver reimbursement that is much more specific to the clinical needs of the resident, it also challenges SNFs to up their ICD-10 coding game.

Continue reading Steven Littlehale’s guest column on mcknights.com