Adoption of the PDPM was intended to be budget neutral. The ICD-10 diagnosis coding is a significant part of the Non-Therapy Ancillary (NTA) component of the PDPM reimbursement system. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that The primary reimbursement is based on the 5-Day assessment, making this assessment critical in terms of accuracy. The PDPM classification system is based on support of the patient's characteristics. Timely nutrition assessments. PDPM is turning what we knew with regard to the Resource Utilization Groups on its head. For example, a . The AHCA Patient Driven Payment Model (PDPM) Resource Center provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in implementing the new Medicare Part A PDPM SNF PPS, effective October 2019. PDPM, unlike RUG-IV, is a Case-Mix Group (CMG) reimbursement method that focuses more on clinically relevant factors and not just volume-based services. In the prior versions of this document, the source for the NTA comorbidity, Inflammatory Bowel Disease, was . Therapy . Swallowing Disorder and/or Mechanically Altered Diet 3 SLP Case Mix Effective October 1, 2019, the Patient Driven Payment Model (PDPM) will improve payments made under the SNF Prospective Payment System (PPS). H&P, Progress note, Consults, Hospital Records Diagnosis must be specific- laterality, anatomical area Unspecified codes- most are RTP Educate to why it is important Admitted Friday ARD Day 4 With the PDPM Diagnosis tool, you can explore 65,000+ ICD-10 codes and verify their validity, identify associated clinical categories, explore NTA and SLP . Each component is scored separately and has federally established rates for each Case-Mix category in the component. Clinical Category (Acute Neurologic or Non-Neurologic) 2. Has a multi-drug resistant organism -1 point 3. Mapping of the ICD-10-CM Recorded in Item I0020B of the MDS Assessment to PDPM Clinical Categories A000 Cholera due to Vibrio cholerae 01, biovar cholerae Acute Infections N/A . or service for purposes of classification under the PDPM's NTA component. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. The Keys to Successful NTA Tracking Under PDPM 1. 1!!!!!©May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! This PDPM model, which took effect in late 2019, was developed for Medicare patients. Master PDPM diagnoses with this powerful free tool. . 1. Infected - 2 points 4. Admittedly, that's a lot to look through. NTA Case Mix Group PDPM Cognitive Level BIMS Score 1 - Cognitively Intact 13-15 2 - Mildly Impaired 8-12 3 - Moderately Impaired 0-7 3-4 . Stage 4 wound - 2 points . Sit to stand as well as chair, bed and toilet transfers should be added and averaged. • Character 3: Nursing Case Mix Group (NSG CMG) • Character 4: NTA Case Mix Group (NTA CMG) • Character 5: Assessment Indicator HIPPS Code PT/OT CMG SLP CMG NSG CMG NTA CMG HIPPS Code A TA SA ES3 NA A B TB SB ES2 NB B C TC SC ES1 NC . Receive Your PDPM Clinical Tools & Checklists. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. The following list summarizes key features of the PDPM: The PDPM program has six payment components. Cognitive Impairment 4. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. Physical Therapy. Speech Comorbidities 3. This means that dietitians must complete their nutrition assessments . NTA NTA Base Rate NTA CMI NTA Adjustment Factor NTA Score Range NTA Case-Mix Group NTA Case-Mix Index 12+ NA 3.25 9-11 NB 2.53 6-8 NC 1.85 3-5 ND 1.34 1-2 NE 0.96 0 NF 0.72 Days in Stay NTA Adjustment Factor 1-3 3.00 4-100 1.00 The score determines NTA payment groups and indices. The NTA case-mix classification groups include: The MDS assessment schedule for PDPM will be dramatically different from the current RUG-IV model. Involve the Interdisciplinary Team. PDPM Grouper Updated - Again. The primary diagnosis is one of the many focus points of this special resident profile that facilities are charged with developing. The primary diagnosis is coded at item I0020B in the MDS and there are several guidelines that CMS . [Don't hold your breath for that raise!] (difference of NE-NF and NA-NB). . PT, OT, and NTA payments would also vary based on the point in the stay. It more accurately accounts for expenses and isn't overshadowed by therapy. NTA has been separated as an independent component, and NTA classification is determined by the presence of certain conditions or the use of certain extensive services that were found to be correlated with increases in NTA costs for SNF patients. Admissions teams and MDS Coordinators should have this list handy at all times for quick reference. Strategy. Discover how HealthPRO Heritage can help you make changes today to set your organization up for success in the future. CMS' Final Rule states Patient-Driven Payment Model (PDPM) will replace the current RUG-IV system October 1, 2019. Mapping of Comorbidities Included in the PDPM NTA Component to ICD-10-CM Codes End of Worksheet Overview Sort Order Comorbidity Description ICD-10-CM Code Description . ICD-10-CM AND THE PDPM Some diagnostic codes which are "Medical Management" or "Acute Neurologic" when primary R26.0 Ataxic gait R26.1 Paralytic gait R26.89 Other abnormalities of gait and mobility (Nonsurgical orthopedic/Musculoskeltal) R27.0 Ataxia, unspecified R27.8 Other lack of coordination R29.1 Meningismus AMDA PDPM Resources & Webinars (free to members) Patient Driven Payment Model Question and Answer Forum; Rajeev Kumar, M.D., "The blanket approach: Best practices for PDPM Success", McKnights Long-Term Care News, 8/23/19; AMDA On-The-Go | PDPM with Dr. Rajeev Kumar; PDPM . Should a resident require IV treatment for an opportunistic infection during their time in your facility, the condition could fetch 7 additional NTA points: 5 for IV medication (O0100H2) and 2 for opportunistic infections (I8000), so it's important to be familiar with those conditions that "count". More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. Unlike most of the MDS, I8000 is a blank, free . The diagnoses are included in the MDS assessment section I and . List the key factors for costs predictive of the OT/PT components of PDPM; List the five SLP components of PDPM, to include the required documentation supporting the presence of each component; Identify the determination factors for classifying a resident into a Non-Therapy Ancillary (NTA) case‐mix group; Recognize the key changes to MDS . Occupational Therapy. The AHCA Patient Driven Payment Model (PDPM) Resource Center provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in implementing the new Medicare Part A PDPM SNF PPS, effective October 2019. Verify valid PDPM primary diagnosis codes. List the steps for SNF payment determination. How are PDPM components adjusted for residents that are living with HIV/AIDS? Items on this list could change at any time with new legislative and The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. With PDPM, there are 28,800 different combinations possible. And aside from the services, many of the comorbidities need to be documented in section I8000. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. Selecting the appropriate diagnosis is one of the elements of the PDPM that has proved elusive to many providers. You will receive resources like our SLP At-A-Glance, Nursing At-A-Glance, NTA At-A-Glance, Request for Information from Referral Source, IDT Checklist, COVID Documentation Guidelines, and so much more. Current RUG-IV HIPPS Code o NTA = All NTA items identified with a value of two or more points on the NTA table. PDPM HIPPS Codes. In this fourth webinar of our six part series, learn which items on the MDS or Medicare claim will be used to determine the NTA score and its impact on payment. In PDPM, five case-mix components are combined with the non-case-mix component, thus establishing a rate . Length of stay will affect reimbursement with NTA payments adjusting on day four, and PT and OT . The PPS used Resource Utilization Groups (RUG) rates to . PDPM and Non-Therapy Ancillaries The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people I've talked to as being better than what we're currently doing. The required MDS data would be entered in the sub-items listed below the item group identifier. PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . Thoroughly review all hospital records prior to admission. PDPM NTA Case Mix Classification Groups NTA Score Range NTA Case Mix Group NTA Case Mix Index NTA HIPPS Character 12+ NA 3.24 A 9-11 NB 2.53 B 6-8 NC 1.84 C 3-5 ND 1.33 D 1-2 NE 0.96 E 0 NF 0.72 F . Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. Under PDPM, 50 conditions and extensive services are considered for NTA classification. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Non-Therapy Ancillary (NTA) classification in PDPM is determined by the presence of certain conditions or the use of certain extensive services that were found to be correlated with increases in NTA costs for SNF patients. Timely nutrition assessments. Non-Therapy Ancillary (NTA) Services - At a Glance The Patient-Driven Payment Model (PDPM) takes effect on October 1, 2019 and represents a significantly different approach to reimbursement for care in Skilled Nursing Facilities (SNFs). Quickly identify associated clinical categories. PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . This update addresses two issues with the NTA comorbidities mapping. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. Non-therapy Ancillary. PDPM PT OT SLP Nursing NTA Non-Case Mix Total PDPM Rate. This coding of HIPPS codes will identify the resident's SNF PDPM classification for payment. The total points correlate with the PDPM CMG, CMI and rate. The presence of these conditions and extensive services is reported by providers . To receive maximum reimbursement, facilities must submit completed MDS paperwork with all NTA comorbidities filled in by length of stay day five. 2. An updated version of the PDPM Grouper has been posted in the Downloads section below with the new version number V2.0002 and will be implemented into the MDS ASAP system on Thursday, January 6, 2022. Below is a comparison of the FY2021 and FY2022 daily rate for a resident with the . 6. This calculation will give you a total PT/OT ADL score for Step 1 in this section. Refer to the CMS PDPM ICD-10 NTA Comorbidity Crosswalk for I8000-derived comorbidities with acceptable ICD-10 codes that map to the NTA component and the NTA item listing for a complete list of NTA conditions/services. Dietitians have key roles to play when it comes to PDPM. Walking 50′ and walking 150′ should be averaged. Clinical Category. Diligence and Support. CMS has added diagnosis codes to the list with the seventh digit of D for use in the ICD-10 code mapping to the NTA comorbidity CC176 "Complications of Specified Implanted Device or Graft" to calculate the PDPM NTA score. PDPM Clinical Update One Month In Nov 2019 Judy Wilhide Brandt, RN, BA, CPC, QCP, RAC‐MT, DNS‐CT 909‐800‐9124 judy@judywilhide.com JudyWilhide.com 1 And you shall rise and show respect to the aged Facebook: /WilhideConsulting Objectives •Review the clinical components of the PDPM rate 7. Education Modules from PDPM U*: Strategy & Financial Implications of PDPM • Deep Dive into Nursing & NTA . Beginning October 1, 2019 providers will need to begin coding a new set of Health Insurance Prospective Payment System (HIPPS) codes in Section Z0100A of the MDS as well as on the Part A claim. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. NTA Componenet NTA Component NTA Comorbidity Score NTA Case Mix Group CMI 12+ NA 3.25 9-11 NB 2.53 6-8 NC 1.85 3-5 ND 1.34 1-2 NE 0.96 0 NF 0.72 Presumption of Coverage Comorbidities Included in NTA Comorbidity Score and Assigned Points Condition/Extensive Service MDS Item Points HIV/AIDS SNF Claim ICD-10 B20 8 Parenteral IV Feeding: Level High Sit to lying and lying to sitting should be scored and averaged. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. The list can be found on pages 35-38 in the CMS PDPM Presentation. In an effort to help make the finalized PDPM clearer, let's take a look at an example of how the per diem will be calculated under the PDPM: Mr. B is a hip replacement patient and has a PT and OT Case-Mix Group of TB, SLP Case-Mix Group of SA, Nursing PDPM Case-Mix Group of CDE2, NTA of NE, and a flat non case-mix rate. This means that dietitians must complete their nutrition assessments . Explore NTA and SLP comorbidities for . The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. CMS has mapped each primary diagnosis to . CMS has identified a list of 50 conditions and services that are associated with increases in NTA costs under PDPM. Skilled Nursing. First and foremost, the interdisciplinary team must become familiar with the list of 50 conditions and extensive services included in the NTA component that impact reimbursement. PDPM Patient Classification Walkthrough - This document has had only a minor revision. Dietitians have key roles to play when it comes to PDPM. All providers will be required to complete an Interim Payment Assessment (IPA) with an Assessment Reference Date (ARD) no later than October 7, 2019 for all SNF Part A patients. However, CMS provides data analysis in this proposed rule indicating that Medicare is paying more than it would have paid under the PDPM than if the RUG-IV classification model had continued. Why does the NTA variable day adjustment impact the first three days of the resident's admission? This diagnosis code should represent the main reason the resident requires SNF care. 9/20/2019 2 RUG-IV Classifies residents into a therapy RUG based on therapy minutes and days. Learn More Resource PDPM Series Part 5: Assessment Requirements. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM and on the NTA list? Driving PDPM Operations: Selecting the Primary Diagnosis. PDPM Clinical Update One Month In Nov 2019 Judy Wilhide Brandt, RN, BA, CPC, QCP, RAC‐MT, DNS‐CT 909‐800‐9124 judy@judywilhide.com JudyWilhide.com 1 And you shall rise and show respect to the aged Facebook: /WilhideConsulting Objectives •Review the clinical components of the PDPM rate Learn More Resource PDPM Series Part 5: Assessment Requirements. Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . ! CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. The list is long — 50 items — most of which are new. In it, you'll find the 1,612 codes that map to the different comorbidities. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 Bladder and Bowel Appliances: First, it corrects an issue where diagnosis . Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . To give you an idea of the daily rate changes [urban] from FY2021 to FY2022, the PT Component will increase $0.78/day, OT $0.73/day, SLP $0.29/day, Nursing $1.35/day, NTA $1.02/day and the Flat Rate $1.22/day. Additionally, PDPM applies variable per diem payment adjustments to three components, PT, OT, and NTA, to account for changes in resource use over a stay. These ICD-10 codes, T82.310D through T85.89XD, can now be coded at I8000 of the MDS to capture 1 NTA point for this . . • MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. It is a shift from the Prospective Payment System (PPS). What services or supplies are included in the non-case-mix component? Per ICD-10 Convention I.A.19. Of the 50 conditions and services, several are relevant for dietitians, including: Parenteral IV feeding level high (7 points): 51% or more of total calories received through IV feeding. PDPM recognizes and rewards those efforts. There are 50 co-morbidities on the NTA list. Mapping of the ICD-10-CM Recorded in Item I0020B of the MDS Assessment to PDPM Clinical Categories A000 Cholera due to Vibrio cholerae 01, biovar cholerae Acute Infections N/A . Code Assignment and Clinical Criteria, "The assignment of a diagnosis code is based on provider's diagnostic statement that the condition exists. CMS believes an adjustment of -5 percent is necessary to restore budget neutral payments. CMS identified a . The idea is that the facility should be paid for the care they are delivering, based on the patient's characteristics. www.pdpmicd10.com | tracey.beattie@pdpmicd10.com NTA Diagnosis Tool CMS identified a list of 50 conditionsand extensive servicesassociated with increases in NTA costs. Because it is a new method for calculation, nursing homes and other long term care facilities could greatly benefit from a PDPM cheat sheet. Luckily, code diving is a lot of fun, right? PDPM recognizes and rewards those efforts. •New MDS item I0020B is used to "map" to one of the PDPM clinical categories •Section J (Surgical Procedures) is used to further adjust clinical classifications, if applicable (must occur during the current hospital stay) •Note: Under the cms.gov PDPM resources is a PDPM ICD-10 mapping tool (revision 8/30/19) A diagnosis of HIV/AIDS tops the NTA point list at eight, while a variety of other patent characteristics — including morbid obesity, immune disorders, epilepsy, and catheterization — receive a single point each. Here is the example for the NTA Component from LWCI's PDPM Rate Chart that is available for purchase on the LWCI Learning Center. To help you prepare for PDPM, we've launched a FREE version of our powerful PDPM Diagnosis Explorer tool. PDPM Clinical Categories for PT and OT 15 Physician Documentation Day 1-8 physician documentation imperative •5-day MDS pays the entire Medicare A stay! . On Oct. 1, CMS will not accept an MDS without a valid primary diagnosis. The resident's RUG was either a therapy RUG or Non-therapy (Nursing) RUG. The adjusted PT, OT, and NTA per diem rates are then added together with the unadjusted SLP and nursing component rates and the non-case-mix component, as is done under RUG-IV, to determine . Under the PDPM structure, there are no rules regarding when nursing home staff can perform an IPA, McCarthy noted, and even . Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. Once again, MDS accuracy is critical to obtain appropriate reimbursement in the PDPM. Providers will be required to know the clinical diagnoses that impact the care of the residents in the facility and the ICD-10 codes for these diagnoses. Medicare PPS/PDPM-NTA • Lung Transplant Status I8000 3 • Major Organ Transplant, Except Lung I8000 2 • Multiple Sclerosis I5200 2 • Opportunistic Infections I8000 2 • Asthma COPD Chronic Lung Disease I6200 2 • Aseptic Necrosis of Bone I8000 2 • Chronic Myeloid Leukemia I8000 2 . 8. Nursing PDPM daily rate NTA Category 1. To help you prepare for PDPM, we've launched a FREE version of our powerful PDPM Diagnosis Explorer tool. By Melanie Tribe-Scott, BSN, RN, RAC-MT, RAC-MTA, QCP | March 16, 2021 The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. To receive maximum reimbursement, facilities must submit completed MDS paperwork with all NTA comorbidities filled in by length of stay day five. special care high etc. Diabetes II - 2 points 2. Response List Displayed Response Response Value B0100 C1000 ADL dependent or not occur CPS Score C0700 Memory OK Memory problem Short-Term Memory Ok The NTA comorbidity diagnosis map continues to have 1535 diagnoses available to map to the 27 NTA comorbidity categories that use MDS item I8000. Many of these are uncommon, and it makes sense to focus on the m ost frequently occurring co-morbidities. Non-therapy RUGs were based on certain resident characteristics. CMS Five of the six are case-mix adjusted. years after the event and are likely not a reason for SNF treatment) for use in the ICD-10 code mapping to the NTA comorbidity CC176 "Complications of Specified Implanted Device or Graft" on the NTA conditions and extensive services list for the purpose of calculating the PDPM NTA score. • Character 3: Nursing Case Mix Group (NSG CMG) • Character 4: NTA Case Mix Group (NTA CMG) • Character 5: Assessment Indicator HIPPS Code PT/OT CMG SLP CMG NSG CMG NTA CMG HIPPS Code A TA SA ES3 NA A B TB SB ES2 NB B C TC SC ES1 NC . Some sources even noting companies are finding losses of $500 to just over $1500 due to missed diagnoses, of both malnutrition and obesity, throughout total admissions spans of residents 2. PDPM MDS Items ! Under PDPM, the diagnosis coded on the 5-day/Initial Minimum Data Set (MDS) in section I0020B (primary reason for skilled stay) largely determines reimbursement for the entire Medicare stay, unless an Interim Payment Assessment (IPA) is necessary. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. Mapping of Comorbidities Included in the PDPM NTA Component to ICD-10-CM Codes End of Worksheet Overview Sort Order Comorbidity Description ICD-10-CM Code Description . Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. Rate Change Impact on Sample Total Joint Resident. What is your current pre-admission process look like today for referrals and admissions? that make up the PDPM daily rate The SLP Case Mix is determined by 4 components 1. The Speech-Language Pathologist classification in PDPM is based on the following three elements: The diagnosis of the clinical category using the ICD-10-CM and ICD-10-PCS which are recorded in MDS item I8000. NTA tracking and identification is tough. A PDPM Example . Our PDPM suite of resources houses tools and checklists to assist you and your organization. Now you can: Navigate through over 65,000 ICD-10 codes. Speech therapy. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. With the major shift from RUG-IV to PDPM, our post-acute care experts have received a multitude of questions revolving around diagnosis coding and how it greatly affects a SNF's . CMS notes that in July 2018, PDPM was finalized and was implemented on October 1, 2019. As under the previous RUG‐IV model, the presence of an AIDS diagnosis continues to be identified through the . The PDPM system is comprised of six components: Non-Case-Mix Base Rate. 9. Review example 6.2 in the textbook. The transition to PDPM on October 1 brought forth a whole new reimbursement system centered around primary clinical characteristics of the patient that is dependent on five categories: PT, OT, SLP, NTA and Nursing. Classifications for NTA points range from 0 points to 12 points. The provider's statement that the patient . Parenteral IV feeding level low (3 points . The Case-Mix rates for each component are summed to establish . In this fourth webinar of our six part series, learn which items on the MDS or Medicare claim will be used to determine the NTA score and its impact on payment. A: You can assign the E66 morbid obesity code if it is specifically documented by the provider, even if the BMI is <40. . The PDPM clinical categories represent groups of similar diagnosis codes, which are used as part of the resident's classification under the PT, OT, and . It shouldn't be, but it is. The NTA component is determined by the score (total number of points) from the condition/extensive service list.

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