Harmony Healthcare Blog

PDPM - Where are We Now Q&A: Part 2

Posted by The Harmony Team on Mon, Feb 10, 2020

Edited by Kris Mastrangelo


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

Question 2 of 9: If the main reason for intensive rehab is because the resident is debilitated from being ill can I use the rehab treatment code that maps from CMS as the primary in I0020B?

www.harmony-healthcare.comhubfsTom studying

The Harmony HealthCARE Specialist recommends that the Rehabilitation treatment codes should not be coded in 10020B if they are symptoms codes, return to provider codes and do not represent the primary reason for the SNF stay.  However, they do support the need for therapy and should be reported in other areas of the MDS.

The Primary diagnosis according to the RAI MDS 3.0 Manual and the Medicare Benefit Policy Manual the primary diagnosis requires:

  • Physician documented diagnosis in the last 60 days.
  • Direct relationship to the resident’s current function, cognition, or mode or behavioral status, medical treatment, nursing monitoring or risk of death in the 7 day look back period.
  • A condition that was treated in the hospital.
  • A condition that developed in a SNF that was treated previously in the hospital.

The following are examples given in the ICD-10-CM Official Guidelines for Coding and Reporting FY 2020.

  • When the purpose for the admission/encounter is rehabilitation, sequence first the code for the condition for which the service is being performed. For example, for an admission/encounter for rehabilitation for right-sided dominant hemiplegia following a cerebrovascular infarction, report code I69.351, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, as the primary diagnosis.
  • If the condition for which the rehabilitation service is being provided is no longer present, report the appropriate aftercare code as the first-listed or principal diagnosis, unless the rehabilitation service is being provided following an injury. For instance, if a patient with severe degenerative osteoarthritis of the hip, underwent a hip replacement and the current encounter/admission is for rehabilitation, report code Z47.1, Aftercare following joint replacement surgery, as the first-listed or principal diagnosis. If the patient requires rehabilitation post hip replacement for right intertrochanteric femur fracture, report code S72.141D, Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing, as the first-listed or principal diagnosis.

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. 

 harmony20 October 29-30 2020 Encore Boston Harbor

Tags: PDPM, 10020B

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