You Are Here:Home/Information/LTC Leader Newsletter
Looking for all of the LTC Leader newsletter’s tips in one place? Visit the new AANAC Tips page to see recent tips from the newsletter.
Not an AANAC member? Join us risk free for 30 days to access articles, expert advice, and FAQs to help you in your role.
Start Your Trial Membership
Delivered twice a month to members, the LTC Newsletter provides expert analysis, updates, tips, and tools.
MDS item I0020B (ICD Code/Resident’s Primary Medical Condition) sets a Medicare Part A resident’s default primary diagnosis clinical category for determining case-mix classification in the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) payment components of the Patient-Driven Payment Model (PDPM). However, a major surgery in the resident’s immediately preceding inpatient hospital stay that is coded in MDS items J2100 – J5000 can push the resident into a surgical category that takes precedence over the default category, resulting in a higher-paying case-mix group.
Item J2100 (Recent Surgery Requiring Active SNF Care) is the lynchpin to achieving a surgical clinical category, serving as the gateway question that determines whether or not a surgery can be captured in J2300 – J5000 (Recent Surgeries Requiring Active SNF Care). Note: See the PDPM Calculation Worksheet for SNFs in chapter 6 of the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual for details on how items in J2300 – J5000 impact classification.
To access this resource, please login or sign up for a free 30-day trial membership.