Ask the Payment Expert about ... ICD-10

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Patricia Boyer,  MSM, NHA, RN  Director of Clinical Services,  Wipfli LLP
Patricia Boyer, MSM, NHA, RN Director of Clinical Services, Wipfli LLP

Why am I hearing so much about ICD-10 lately?

ICD-10 should be on everyone's radar again. As we move into the value-based payment system and the Patient Driven Payment Model, ICD-10 will be impacting skilled nursing reimbursement.

VPB initially removes 2% of payment from all SNFs and then returns a percentage of it back — if the SNF earns its return — by meeting or exceeding a specific measure.

Diagnoses are used for risk adjustors in some of these quality measures. It is, therefore, important that all diagnoses impacting the resident are captured and that they are correctly coded, with specificity, in order for them to be used as exclusions or risk adjusters.

Diagnoses specifically impact these measures: Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay); Percent of Patients or Residents with Pressure Ulcers that are New or Worsened; and Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function.

The specificity of ICD-10 is the way facilities can communicate the severity of a patient's medical condition. This is key in determining the level of reimbursement. Diagnosis will impact the therapy components with PDPM. A resident with cognitive impairment is going to increase the SLP reimbursement more than PT or OT.  Conversely, a diagnosis of amputation is going to increase the PT and OT components over the SLP.

Now is the time to review ICD-10 coding processes in your facility. Are the coding conventions being followed? Are non-specific codes being assigned? It is important that staff are trained and competent in ICD-10.

Please send your payment-related questions to Patricia Boyer at ltcnews@mcknights.com.