Harmony Healthcare Blog

ICD-10 Coding and Skilled Nursing Care

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Sep 09, 2019


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

MDS Nurses do not need to be expert coders, but it is essential that they connect the dots between the diagnoses and rationale for skilled care.  

PDPM flips the script and highlights nursing care.  For the last 2 decades, therapy dominated the RUGs classification at 92%.  This means that skilled claims leaned on therapy as the skilled qualifier.  Although Harmony Healthcare International (HHI) consistently preaches that “nursing rules the world” and that “nursing always anchors the patient for skilled coverage”, many providers may have relied solely on therapy for coverage.

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Topics: ICD-10

Top 5 Strategies: ICD-10 Coding and Skilled Diagnosis

Posted by Pam Duchene on Thu, Aug 22, 2019


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

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 ICD-10 Codes that best reflect the patient’s reason for Skilled Medicare Coverage upon admission to the SNF.

There are 3 outcomes when selecting patient ICD-10 Codes:

  • Return to Provider
  • Resolved in Hospital
  • Reason for Skilled Care
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Topics: ICD-10

ICD-10 Coding: Diagnosis of B20 (HIV)

Posted by The Harmony Team on Tue, May 09, 2017


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

Audits this week prove to be interesting.  As we focus on the accurate coding of HIV, there seems to be opportunity with understanding the definition and the significance in the reimbursement. 

Often times the need for additional supportive documentation in determining the appropriate ICD-10 for HIV.  Limited information is in the medical record.  To code B20, the condition is active and meets criteria versus Z21, asymptomatic HIV.

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Topics: ICD-10

The ICD-10 Transition: The Biggest Fear for SNF Providers

Posted by The Harmony Team on Thu, Jun 25, 2015

With an implementation date of October 1, 2015 looming, the transition to ICD-10 is in full swing.   In speaking daily with Skilled Nursing Facility Operators and Administrators, it is apparent that while many leaders understand that ICD-10 is coming, they lack a proper transition plan to ensure that their Skilled Nursing Facility (SNF) is fully prepared for the change.

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Topics: ICD-10

An Introduction to ICD-10

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Dec 04, 2014

With the upcoming transition date of October 1, 2015 from ICD-9 to ICD-10 quickly approaching, it is important to note the coding changes from ICD-9 to ICD-10.  Specific areas of this transition will impact skilled nursing facilities and the coding of both the short and long term population in the facility.

ICD-9 has been utilized for over 30 years for a number of uses in the American Healthcare system.  These uses include reimbursement, payer contracts and coverage determinations, assessment of provider performance with disease management, and monitoring utilization patterns.  It has also been utilized for providing criteria for inpatient care vs. outpatient services, tracking the severity of illness data including mortality and complications, as well as public health tracking
and reporting.

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Topics: ICD 9 Coding, MDS Coding, ICD-10, ICD-9

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