CMS has updated the patient classification FAQ on February 14, 2019.  In this updated FAQ, CMS clarifies where the primary reason for the SNF stay will be coming from.

It was previously noted that the ICD-10 code that reflects the reason for the SNF stay would pull from form MDS section I8000A.  However, this updated patient classification FAQ clarifies that this critical piece to the patient classification system will now pull from a newly added line item in Section I, I0200B.  This item will ask what the main reason the patient is being admitted to the SNF.  It will be coded with item I0020 when coded as any 1-13 category responses.

This updated fact sheet explains, “ICD-10-CM codes, coded on the MDS 3.0 in Item I0020B, are mapped to a PDPM clinical category. This clinical classification, based on the primary SNF diagnosis, may be adjusted in cases where the patient received a surgical intervention during the preceding hospital stay associated with that diagnosis. These surgical procedures are captured in items J2100 through J5000 on the MDS. On the basis of the patient’s primary diagnosis and presence of a surgical category, the patient is then classified into one of the ten clinical categories listed in the table below”.

PDPM Clinical Categories- no change


Collapsed PT and OT Clinical Categories-
no change

A mapping of the ICD-10 diagnosis and/or surgical category used to classify a SNF resident into each of the 10 clinical categories is available on the SNF website at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html

In addition, there are new items to MDS section J (J2100-J5000).  This section will be used to capture if a surgical procedure was performed during the most recent qualifying hospital stay. Providers will need to check the boxes, and this will be used with the diagnosis code recorded in section I0020B for classification in to the PT and OT case-mix classification groups.

 


 

Gina Tomcsik
Director of Compliance and Regulatory Strategy