Patient-Driven Payment Model (PDPM)

The Patient-Drive Payment Model (PDPM) is scheduled to begin Oct. 1, 2019, and AANAC is here to help!

The Centers for Medicare & Medicaid Services released the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule, which solidified their plans to implement PDPM.  PDPM is set to replace the RUG-IV case-mix classification model that has been the hallmark of SNF PPS for years. This new payment system will be unlike anything SNFs have seen before! You and your staff have a lot to do to get ready for PDPM, and AANAC will be with you the entire way.  Visit this page frequently to get tools, education, and resources to help you lead your team readiness.

Q&A: I have noticed that there are many ICD-10-CM diagnosis codes that result in “return to provider" on the PDPM ICD-10 Mappings. Is it true that we cannot use these codes?

Posted By: Jennifer LaBay, RN, RAC-MT, RAC-MTA
Post Date: 06/18/2019

Question: I have noticed that there are many ICD-10-CM diagnoses codes that result in “return to provider" on the PDPM ICD-10 Mappings. Is it true that we cannot use these codes? For example, a resident with "Unspecified Macular Degeneration" maps to the "return to provider" category.

 

Answer: The only concern with return to provider codes is that code cannot be used in I0020B on the MDS to establish the primary reason for skilled services which sets the PT, OT, and potentially ST components of the score under PDPM. The return to provider codes can still be used to support the care and services provided to the resident for NTA and SLP-related comorbidities. 


Jennifer LaBay, RN, RAC-MT, RAC-MTA

 

 


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