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The Patient-Drive Payment Model (PDPM) is here, and AANAC will continue to help you through the transition. Visit this page frequently for new tools, education, and resources for ongoing success under PDPM.
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
Reviewed and revised on 12/5/19