Harmony Healthcare Blog

PDPM - Where are We Now Q&A: Part 6

Posted by The Harmony Team on Tue, Feb 25, 2020


Edited by Kris Mastrangelo

C.A.R.E.

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


Kris Presenting MontanaQuestion 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. Most professional coders are trained by AHIMA, the American Health Information Management Association, the credentialing body for ICD-10 coders at all levels.  Their course is focused on coding for hospitals and to maximize the hospital's reimbursement.  ICD-10 codes from their perspective are very specific to detail all aspects of the patient's status.  The coders are focused on why the patient required a hospitalization which may not be the same reason for the SNF stay.  These coders also include multiple diagnoses to describe conditions that are present but may not have an impact on a SNF stay, e.g., presence of a pacemaker.  While the SNF needs to know that the patient has a pacemaker, the coding of the pacemaker is not needed for billing and should not be used as a primary diagnosis.  Many of the codes that describe the presence of a device are considered "Return to Provider" if used as a primary diagnosis.  The claim for SNFs (UB-04) has 25 spaces for ICD-10 codes, the MDDS has 10 additional spaces for codes.  The codes for these reimbursement vehicles need to be chosen carefully.  They need to describe the patient and their reason for admission to the SNF to "tell the story" of the patient.  Coders use very specific ICD-10 codes.  In the SNF setting, many of these very specific codes are "Return to Provider" status.  Dementia, for example, maybe the reason for requiring a SNF stay, however, any dementia code other than Unspecified Dementia, is a return to provider, while the Unspecified Dementia may be used as a primary code to describe the reason for the SNF stay.  While it would be advantageous for many reasons to have a medical records coder, the cost of the position is often not supported by the return via the coding.  Many MDS Coordinators and other nursing staff are excellent at choosing ICD-10 codes that describe the patient's status and the reason for SNF stay. 

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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. 


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Tags: Coding, PDPM, AHIMA

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