How many PDPM codes are there?

A lot has been made of the complexity of PDPM. We've all heard by now there are more than 28 thousand code combinations.

What is PDPM coding?

The Patient-Driven Payment Model (PDPM) is a new case-mix classification system for classifying skilled nursing facility (SNF)/swing-bed patients in a Medicare Part A covered stay into payment groups under the SNF prospective payment system (PPS).

What is the default PDPM code?

Default Billing

The default code under PDPM is ZZZZZ, instead of the default.

What are the 6 components of PDPM?

In the PDPM, there are five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Non-Therapy Ancillary (NTA), and Nursing. Each resident is to be classified into one and only one group for each of the five case-mix adjusted components.

How many MDS assessments are currently required under PDPM?

Under PDPM (effective October 1, 2019), there are 3 SNF PPS assessments: the 5-day Assessment, the Interim Payment Assessment (IPA) and the PPS Discharge Assessment. The 5- day assessment and the PPS Discharge Assessment are required.

PointRight Education: PDPM: ICD-10 Codes and the Drivers of PDPM

How many scheduled PPS assessments are there?

The Medicare-required PPS assessment schedule includes 5-day, 14-day, 30-day, 60-day, and 90-day scheduled assessments. Except for the first assessment (5-day assessment), each assessment is scheduled according to the resident's length of stay in Medicare-covered Part A care.

What is an IPA MDS assessment?

The Interim Payment Assessment (IPA) is an optional MDS assessment performed after the initial assessment, usually after a change in patient's condition, to capture a change in patient characteristics.

How many NTA points are there?

The individual NTA conditions have points ranging from 1 to 8. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. The patient's NTA comorbidity score is the sum of the points associated with each relevant comorbidity.

What do hipps codes mean?

(HIPPS Codes)

Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets of patient characteristics (or case-mix groups) health insurers use to make payment determinations under several prospective payment systems.

How many NTA items come from MDS?

As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. Section I8000 alone has 27 of these conditions, while sections K, M, N, and O also have items that can contribute to the NTA score.

What is revenue Code 022?

the claim with revenue code 0022. This code indicates that this claim is being paid under SNF PPS. This revenue code can appear on a claim as often as necessary to indicate different HIPPS rate code(s) and assessment periods.

What does NTA mean in PDPM?

Under PDPM, CMS has broken the singular nursing component of RUG-IV into two separate components – Nursing and Non-Therapy Ancillary (NTA) – to adeptly account for the wide-ranging variations within the skilled population.

What is PDPM and PDGM?

The intent behind these administrative changes, commonly known as the Patient-Driven Payments Model (PDPM) for skilled nursing facilities (SNFs) and the Patient-Driven Groupings Model (PDGM) for home health care, is to improve the quality of patient care, promote the overall health and wellbeing of the Medicare ...

What is a category code?

Category codes are user defined codes to which you can assign a title and a value. The title appears on the appropriate screen next to the field in which you type the code.

What is CMS PDPM?

Overview. In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.

How do you calculate PDPM?

The ABILITY CAREWATCH PDPM calculator uses the payment for each component and is calculated by multiplying the case-mix index (CMI) that corresponds to the patient's case-mix group (CMG) by the wage adjusted component base payment rate, then by the specific day in the variable per diem adjustment schedule when ...

What is PDPM payment model?

The Medicare Patient-Driven Payment Model (PDPM) is a major overhaul to the current skilled nursing facility (SNF) prospective payment system (PPS). It is designed to address concerns that a payment system based on the volume of services provided creates inappropriate financial incentives.

What is a hipps modifier?

The CMS HIPPS codes contain a three position code to represent the RUG-III of the SNF resident, plus a 2-position assessment indicator to indicate which assessment was HIPPS modifier codes have been establ​ished for each type of assessment used to support Medicare payment.

What is the function score in PDPM?

The function score for patient classification under PDPM is now calculated using data from Section GG of the MDS 3.0 (Functional Abilities and Goals) rather than Section G items. This advances CMS's goal of using standardized assessment items across payment settings. PDPM makes no changes to how Section GG is coded.

What does NTA mean in MDS?

Background. Under the Resource Utilization Group, Version IV (RUG-IV) case-mix classification model, nursing and non-therapy ancillary (NTA) costs are addressed under a single component, the nursing component.

What are NTA services?

Some examples of “services” that are captured for NTA classification include: IV Medication, Radiation, Suctioning, Infection Isolation and Feeding Tube.

What are SLP comorbidities?

There are twelve SLP-related comorbidities. These include aphasia, CVA, TIA or stroke, hemiplegia or hemiparesis, traumatic brain injury, tracheostomy or ventilator, laryngeal cancer, apraxia, dysphagia, ALS, oral cancers, or speech and language deficits.

When should an IPA be completed?

The IPA Assessment must be completed (item Z0500B) within 14 days after the ARD (ARD + 14 days) and must be submitted electronically and accepted into the QIES ASAP system within 14 days after completion (item Z0500B) (completion + 14 days).

What is the look back period for IPA?

How is an ARD affected when it comes to an IPA? The ARD would include a 3-day look back period and the reference date is designated as the date the provider completes the assessment.

What is a SNF Part A interrupted stay?

An “interrupted” stay is one in which a patient is discharged from Part A SNF care and subsequently readmitted under the following TWO conditions: The patient returns to Part A care in the same SNF (not a different SNF); AND: The patient returns within three days or less (the “interruption window”)