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ICD-10 Codes: Connecting the Dots on Complex Medical Residents

By Caralyn Davis, Staff Writer - September 24, 2019

The Patient-Driven Payment Model (PDPM) is designed to reallocate Medicare Part A payments made in the Skilled Nursing Facility Prospective Payment System (SNF PPS) to currently underserved beneficiaries, i.e., residents who have more clinically complex needs and high nontherapy ancillary (NTA) costs. To navigate PDPM, nurse assessment coordinators (NACs) will need to be able to code the appropriate active diagnoses, conditions, and treatments for these complex medical residents on the MDS.


Researching and using accurate ICD-10-CM diagnosis codes is critical to achieving appropriate PDPM case-mix groups for these residents. The ICD-10 code for the resident’s primary diagnosis for the SNF stay, reported in new item I0020B (ICD Code/Primary Medical Condition), will determine their default primary clinical category for classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) payment components. ICD-10 codes entered in I8000 (Additional Active Diagnoses) also can factor into comorbidities that would further impact the SLP component, as well as the NTA component.