These files should be used in conjunction with the discussions found in the FY 2019 SNF PPS NPRM and accompanying files to better understand the process for resident classification under PDPM. The second file is a spreadsheet-based grouper tool which can be used to test certain combinations of MDS items used to classify residents under the proposed PDPM, and observe their impact on the resident’s PDPM classification. The first file provides a narrative step-by-step walkthrough that would allow stakeholders to manually determine a resident’s PDPM classification based on the data from an MDS assessment. To assist stakeholders in understanding the process by which SNF residents would be classified into PDPM payment groups, we are providing three files. Note: For the most current PDPM ICD-10 code mapping, please refer to the PDPM Resources section of the Patient Driven Payment Model webpage. This process is further discussed in the FY 2019 SNF PPS NPRM. For these situations, the alternative clinical category is shown in columns D and E in the diagnosis clinical category file. The staff would review the information sent by the preceding hospital stay to identify any procedures defined in these surgical clinical categories. The surgical procedure code lists provided will be used as a reference by the skilled nursing facility staff to augment the resident’s clinical category classification. There are three surgical clinical categories where this may occur major joint replacement or spinal surgery, orthopedic surgery (except major joint replacement and spinal surgery) and non-orthopedic surgery. For a subset of these ICD-10-CM diagnosis codes, the clinical category will be modified if there were specific related surgical procedures performed in the hospital stay immediately preceding admission to the skilled nursing facility. These files provide a crosswalk between the ICD-10 diagnosis and procedure codes and the ten PDPM clinical categories.Īll ICD-10-CM diagnosis codes have been assigned to a default clinical category shown in column C in the diagnosis clinical category file. SNF PDPM ICD-10 Diagnosis and Procedural Code CrosswalkĪs discussed in Section V.D.3.b, the proposed PDPM would use ICD-10 diagnosis and procedural codes in order to classify SNF residents into one of ten PDPM Clinical Categories, which would then be used to further classify the resident for payment purposes under PDPM. We would note that, as described in the FY 2019 SNF PPS NPRM, we make use of both the SNF PDPM and SNF PMR technical reports in our discussion of the proposed PDPM. Similarly, the SNF PDPM Technical Report discusses the additional analyses conducted, many in response to stakeholder feedback on the ANPRM, in development of the proposed PDPM. With release of the ANPRM in May 2017, we released an accompanying technical report, which described all of the research and analyses conducted to develop the RCS-I model. Below are several items we have posted concurrent with the FY 2019 SNF PPS NPRM to assist stakeholders in reviewing and commenting on the proposed PDPM. This resulted in significant changes to the RCS-I model, which have prompted us to rename the proposed model discussed in the FY 2019 SNF PPS Notice of Proposed Rulemaking (NPRM) the SNF Patient Driven Payment Model (PDPM). Since the ANPRM, we continued our stakeholder engagement efforts to address the concerns and questions raised by commenters with RCS-I. In May 2017, CMS released an Advanced Notice of Proposed Rulemaking (ANPRM) which outlined a new case-mix model, the Resident Classification System, Version I (RCS-I), that would be used to replace the existing RUG-IV case-mix model, used to classify residents in a covered Part A stay into payment groups under the SNF PPS.
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