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I0020B: Getting the PDPM Primary Clinical Category for PT, OT, and SLP

By Caralyn Davis, Staff Writer - January 09, 2019

The fiscal year (FY) 2019 skilled nursing facility prospective payment system (SNF PPS) final rule included now-inaccurate information related to how the default primary diagnosis clinical category will be determined for the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) components of the patient-driven payment model (PDPM) that will implement on Oct. 1, 2019. The final rule cited MDS item I8000 (additional active diagnoses) as the source of the primary SNF diagnosis code that would drive the default primary clinical category, stating, “… PDPM would use ICD-10-CM diagnosis codes entered in the first line of section I8000 on the MDS assessment to assign residents to clinical categories for classification and payment purposes in three PDPM payment components (PT, OT, and SLP).”