Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency • Survey
The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is adding a new diagnosis code, U07.1, COVID-19, to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective April 1, 2020. The Index and Tabular Addenda and the Coding Guidelines for the new diagnosis code U07.1, COVID-19, can be accessed on the CDC website at https://www.cdc.gov/nchs/icd/icd10cm.htm.
The Centers for Medicare & Medicaid Services (CMS) has posted an updated FY 2020 PDPM Mappings file that includes the ICD-10 CMS code “U07.1 – 2019-nCoV acute respiratory disease” as an appropriate code for MDS item I0020B, the primary reason for the skilled nursing facility (SNF) stay. For Minimum Data Set (MDS) assessments with an Assessment Reference Date (ARD) of April 1, 2020, or later, this code, U07.1, maps to the PDPM Pulmonary clinical category for the PT, OT and SLP components. It does not currently impact either the PDPM Nursing or the NTA component. Providers should check with their software vendors to confirm when the update for this change has been applied.
Harmony Healthcare International (HHI) recommends that an FY 2020 ICD-10-CM Code book be available for the MDS Coordinator to access all other current codes. As the name states, the Patient Driven Payment Model (PDPM) compensates by patient characteristics and the associated ICD-10 Codes. Hence, it is imperative to identify and properly document the correct ICD-10 Codes that best reflect the patient’s reason for Skilled Medicare Coverage upon admission to the SNF. ICD-10-CM Codes capture a resident’s clinical conditions to support services billed for Medicare Part B in addition to Managed Care and Medicare Part A.
MDS Nurses do not need to be expert coders, but they must be able to connect the dots between the diagnoses and the rationale for skilled care. It is essential that they understand or can access basic coding guidelines easily and are comfortable using an ICD-10 Coding manual. It is not easy to identify and select the most specific, accurate code. The first step is to become familiar with all the Official Coding Guidelines that are available at https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2020_final.pdf and usually in the front of ICD-10 Coding manuals.
The Health Insurance Portability and Accountability Act (HIPAA) mandates that all healthcare entities adhere to official coding guidelines. A trend of questionable, potential ICD-10 Coding errors on SNF claims, such as incorrect 7th characters, can trigger scrutiny and Additional Documentation Requests from CMS. It is recommended that MDS Coordinators are proficient in using the alphabetical index and then the tabular list in their ICD-10 manual, that they carefully check chapter headings, coding abbreviations and conventions to facilitate accurate coding and they query the physician for clarity and greater specificity when indicated. The importance of understanding inclusion/exclusion terms and other conventions, a process for querying the physician timely to capture a diagnosis within the Assessment Reference Date (ARD) observation period, and interdisciplinary collaboration with your team, cannot be overstated.
When it is best to check an ICD-10 Code on-line, use the Centers for Disease Control and Prevention (CDC) beta version of their ICD-10-CM Browser tool at https://icd10cmtool.cdc.gov/ that became available in January. Here are a few hints to get you started:
- Start by selecting the fiscal year you want to start (top left)
- Type text into the Search box
- Use terms or parts of terms
- Make it as specific as you can (e.g., “syndrome” returns numerous results)
- It will search as you type (partial matches work as it looks for text, not words)
- Press “Enter” if you want the search saved to your field history
- Use terms or parts of terms
- See your results
- By volume and the number of hits in the Index to Diseases and Injuries
- Click a code to display the entry for it in the Tabular List of Diseases
- That code will be highlighted in yellow when the Tabular List opens
- Be sure you hover over the icons next to the Tabular entry for the instructions specific to that code, section or chapter (Note the Legend above the icons)
- To search directly in the Tabular List without first searching the Indexes and Tables:
- Type the code in the “Find code in Tabular…” box
- Click the View button or your Enter key
- To save a search as a Favorite or Bookmark
- Perform a search
- Type Control-D
- Give the Bookmark or Favorite a name
- Searches can also be saved in your browser’s Form History for recall
- Set browser to enable form field history
- When searching you must hit the Enter key to store the search term unless searching directly for a tabular code (View button or Enter key will work)
- When the search is in History, you can recall it by:
- Clicking twice in the “Search” or “Find Code” field or
- Start typing in the field and it will auto-populate from the history
Besides the 273 new ICD-10-CM codes that became effective October 1, 2019, there were 30 revised codes and 21 deleted codes. Code changes for FY 2020 included atrial fib, DVT, and pressure induced deep tissue damage.
Despite excellent progress that most MDS Coordinators have made with the basic coding rules, there is often an opportunity for further growth, to stay current with the latest updates, and to learn the nuances of coding. ICD-10 Coding greatly impacts both clinical decisions and reimbursement. Harmony Healthcare International (HHI) appreciates the diligent efforts of facilities to code accurately and is available to assist when you have questions.
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Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have. You can contact us by clicking here. Looking to train your staff? Join us in person at one of our our upcoming Competency/Certification Courses. Click here to see the dates and locations.