Harmony Healthcare Blog

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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.

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency

As the Coronavirus pandemic evolves, we are actively observing our world change at an exponential pace.  Despite this rapid change, the commitment level of the team at Harmony Healthcare International (HHI) has not deviated from our uppermost dedication to you, your staff and most importantly, to our role in helping you provide the highest quality care to your residents.

First, and most importantly, the safety of you, your staff and your residents remain the number one priority.  Most of you have readily adapted and maintained our Harmony Healthcare International (HHI) services using remote access.  We are grateful for your flexibility and appreciate your awareness of the potential risks of missing your monthly medical record reviews.  Many scenarios cannot be recouped and a heightened focus on care and reimbursement is essential to successfully navigate the upcoming months.

This leads me into a very important subject matter that fits the current world situation:

Isolation of patient’s with infectious diseases.

C.A.R.E.

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1. Number one goal is to prevent the virus from entering the Skilled Nursing Facility.
2. If a virus enters the Skilled Nursing Facility, place full court press with goal to prevent the spread of infection.
3. If there is a confirmed or suspected influenza outbreak, implement Outbreak Control Measures.

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency

Question 9 of 9: Where can we obtain data from cost reports for comparison?

Cost reporting data can be found at the following link:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports

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Question 8 of 9: Can you talk a little bit about the use of Return-to-Provider codes ?

When coding the MDS in Section I0020B, we need to identify the primary medical diagnosis.  This represents the reason a person skilled and allows them to access their skilled Medicare A benefit.  These medical diagnosis codes are utilized with the CMS crosswalk to determine the PDPM clinical category.

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency

Question 7 of 9: In order to capture IV fluids for hydration, do we need documentation supporting reason is for hydration/nutrition, or can we assume IV fluids are delivered for this purpose?

Harmony Healthcare International (HHI) recommends reviewing the hospital documentation including the MAR prior to establishing the ARD for the 5-day assessment so that all resident complexities are included.

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Question 6 of 9: I am curious as to why organizations do not hire a credentialed coder/Medical Records professional to abstract, review, code, and audit for the primary and secondary diagnoses codes using ICD-10-CM.  Do you hear this as a recommendation?  Do you recommend? 

Harmony Healthcare International (HHI) has found that professional coders are not needed by SNF facilities for several reasons.

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Question 5 of 9: Is it appropriate to use diagnoses added by consulting physicians?

It is appropriate to use diagnoses added by consulting physicians, in addition to those listed by the admitting physician and those identified by non-physician providers such as nurse practitioners and physician assistants.  According to the RAI User’s Manual, active diagnoses are intended to code diseases that have a direct relationship to the resident’s current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death. 

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Question 4 of 9: For the certification form on admission, how many days does the MD/NP have to sign? If a person admits late on a Friday and the practitioner is not in the facility until Tuesday or after, would that suffice?

According to the Medicare Benefit Policy Manual Chapter 8 – Coverage of Extended Care (SNF) Services under Hospital Insurance. 40- Physician Certification and Re-Certification for Extended Care Services,

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“Childhood Trauma leads to a Shorter Lifespan.”

Thank you for all the comments and notes on the Medicare Minutes. Many of you are seeking more information on Trauma Informed Care. As I have said since the draft RoP Requirements of Participationwas published, (I read it in a Cambridge Massachusetts Hotel while my daughter Savannah wrote her college application essays), CMS is on top of their game and ahead of the curve.

The Skilled Nursing Industry is working diligently to understand how to provide care to an individual with Trauma. Trauma can be caused by a multitude of events within a lifetime. However, it is prudent to educate staff on root causes from childhood events.