Review-other-MDS-changes.pptx

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Review Other MDS Changes
1/24/2023

Changes to the MDS for October
2019
• Chapter 2
• This chapter has been extensively revised for this year’s manual. Due to the scope of the
revisions, individual changes have not been recorded and tracked in this Change Table.
Users are encouraged to review the chapter in its entirety.
• Chapter 3, Section C
• Because a PDPM cognitive level is utilized in the speech language pathology (SLP)
payment component of PDPM, assessment of resident cognition with the BIMS or Staff
Assessment for Mental Status is a requirement for all PPS assessments. As such, only in
the case of PPS assessments, staff may complete the Staff Assessment for Mental
Status for an interviewable resident when the resident is unexpectedly discharged
from a Part A stay prior to the completion of the BIMS.
o In this case, the assessor should enter 0, No in C0100: Should Brief Interview for Mental
Status Be Conducted? and proceed to the Staff Assessment for Mental Status.

Changes to the MDS for October
2019
• Section GG
• For the Interim Payment Assessment (A0310B=08), the assessment period for Section GG
is the last 3 days (i.e., the ARD and two days prior).
• For Section GG on the IPA, providers will use the same 6-point scale and activity not
attempted codes to complete the column “Interim Performance,” which will capture the
interim functional performance of the resident.
• The ARD for the IPA is determined by the provider, and the assessment period is the last 3
days (i.e., the ARD and the 2 calendar days prior).
• It is important to note that the IPA changes payment beginning on the ARD and continues
until the end of the Medicare Part A stay or until another IPA is completed.
• The IPA does not affect the variable per diem schedule.
• GG0110 Prior Device Use
• GG0110C, Mechanical lift, includes sit-to-stand, stand assist, stair lift, and full-body-style
lifts.

This document is for general informational purposes only.
It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities.
© Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2018
Primary Diagnosis
• #14 eliminated
• I0020B is now for
the primary
diagnosis code
on each PPD
MDS.
1/24/2023
Section I
Indicate the resident’s primary medical condition category that best describes the primary reason for the
Medicare Part A stay; then proceed to I0020B and enter the International Classification of Diseases (ICD)
code for that condition, including the decimal.

ACTION PLAN
• Accurate identification of the Primary Diagnosis
• ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Page 107 of 120
• Section II. Selection of Principal Diagnosis
• The circumstances of inpatient admission always govern the selection of principal
diagnosis. The principal diagnosis is defined in the Uniform Hospital Discharge Data Set
(UHDDS) as “that condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care.”
• Since that time the application of the UHDDS definitions has been expanded to include all
non-outpatient settings (acute care, short term, long term care and psychiatric hospitals;
home health agencies; rehab facilities; nursing homes, etc). The UHDDS definitions also
apply to hospice services (all levels of care).
• In determining principal diagnosis, coding conventions in the ICD-10-CM, the Tabular List
and Alphabetic Index take precedence over these official coding guidelines.
• (See Section I.A., Conventions for the ICD-10-CM)

Section J2100
1/24/2023
• Recent Surgery Requiring Active SNF Care
• 1. Ask the resident and his or her family or significant other about any
surgical procedures that occurred during the inpatient hospital stay that
immediately preceded the resident’s Part A admission.
• 2. Review the resident’s medical record to determine whether the resident
had major surgery during the inpatient hospital stay that immediately
preceded the resident’s Part A admission.
– Medical record sources include medical records received from facilities where the
resident received health care during the inpatient hospital stay that immediately
preceded the resident’s Part A admission, the most recent history and physical,
transfer documents, discharge summaries, progress notes, and other resources as
available.

Section J2100
1. Identify recent surgeries:
• The surgeries in this section must have been documented by a physician (nurse
practitioner, physician assistant, or clinical nurse specialist if allowable under state licensure
laws) in the last 30 days and must have occurred during the inpatient stay that immediately
preceded the resident’s Part A admission.
– • Medical record sources for recent surgeries include progress notes, the most recent
history and physical, transfer documents, discharge summaries, diagnosis/problem list, and
other resources as available.
– • Although open communication regarding resident information between the physician and
other members of the interdisciplinary team is important, it is also essential that resident
information communicated verbally be documented in the medical record by the physician to
ensure follow-up.
– • Surgery information, including past history obtained from family members and close
contacts, must also be documented in the medical record by the physician to ensure validity
and follow-up.

Section J2100
• 2. Determine whether the surgeries require active care during the SNF
stay:
• Once a recent surgery is identified, it must be determined if the surgery
requires active care during the SNF stay. Surgeries requiring active care
during the SNF stay are surgeries that have a direct relationship to the
resident’s primary SNF diagnosis, as coded in I0020B.
– • Do not include conditions that have been resolved, do not affect the
resident’s current status, or do not drive the resident’s plan of care during the
7-day look-back period, as these would be considered surgeries that do not
require active care during the SNF stay.
– • Check the following information sources in the medical record for the last
30 days to identify “active” surgeries: transfer documents, physician progress
notes, recent history and physical, recent discharge summaries, nursing
assessments, nursing care plans, medication sheets, doctor’s orders,
consults and official diagnostic reports, and other sources as available.

Section J2100
• In the rare circumstance of the absence of specific documentation that
a surgery requires active SNF care, the following indicators may be
used to confirm that the surgery requires active SNF care:
• The inherent complexity of the services prescribed for a resident is such that
they can be performed safely and/or effectively only by or under the general
supervision of skilled nursing. For example:
– — The management of a surgical wound that requires skilled care (e.g.,
managing potential infection or drainage).
– — Daily skilled therapy to restore functional loss after surgical procedures.
– — Administration of medication and monitoring that requires skilled nursing.
•

1/24/2023
Generally, major surgery for item
J2100 refers to a procedure that
meets the following criteria:
1. the resident was an
inpatient in an acute care
hospital for at least one day in
the 30 days prior to admission
to the skilled nursing facility
(SNF), and
2. the surgery carried some
degree of risk to the resident’s
life or the potential for severe
disability.

Section K
• Section K : When not a resident
• Removed for Mechanically Altered
• Diet and intake via parenteral/enteral
• Feedings.
1/24/2023

Section O
Section O
Respite Care removed

Section O
• Finally, when coding for isolation, the facility should review the
resident’s status and determine if the criteria for a Significant
Change of Status Assessment (SCSA) is met based on the effect
the infection has on the resident’s function and plan of care
• Regardless of whether the resident meets the criteria for an
SCSA, a modification of the resident’s plan of care will likely need
to be completed.

1/24/2023
Code only medically necessary therapies that
occurred after admission/readmission to the
nursing home that were :
(1)ordered by a physician (physician’s
assistant, nurse practitioner, and/or clinical
nurse specialist as allowable under state
licensure laws) based on a qualified
therapist’s assessment (i.e., one who
meets Medicare requirements or, in some
instances, under such a person’s direct
supervision) and treatment plan,
(2) documented in the resident’s medical
record, and
(3)care planned and periodically evaluated to
ensure that the resident receives needed
therapies and that current treatment plans
are effective.
Therapy treatment may occur either inside or
outside of the facility.
1. Individual minutes - record the total number of minutes this therapy
was administered to the resident individually since the start date of the
resident's most recent Medicare Part A stay (A2400B).

Section O - 34
• Item Rationale
• Health-related Quality of Life
• Maintaining as much independence as possible in activities of daily living,
mobility, and communication is critically important to most people. Functional
decline can lead to depression, withdrawal, social isolation, breathing
problems, and complications of immobility, such as incontinence and
pressure ulcers/injuries, which contribute to diminished quality of life. The
qualified therapist, in conjunction with the physician and nursing
administration, is responsible for determining the necessity for, and the
frequency and duration of, the therapy services provided to residents.

PDPM Modes of Therapy
1/24/2023
• Group Therapy plus Concurrent Therapy will be limited to 25% of
total minutes per discipline
• Group and Concurrent minutes will be counted in full rather
than one-quarter and one-half respectively as in RUGs-IV
• PPS End of Stay Assessment will monitor therapy utilization
• A non-fatal error warning will appear on the Validation Report if
the 25% amount is exceeded

Modes of Therapy
• Modes of Therapy
• A resident may receive therapy via different modes during the same day or
even treatment session. These modes are individual, concurrent and group
therapy.
• When developing the plan of care, the therapist and assistant must
determine which mode(s) of therapy and the amount of time the resident
receives for each mode and code the MDS appropriately.
• The therapist and assistant should document the reason a specific mode of
therapy was chosen as well as anticipated goals for that mode of therapy.
• For any therapy that does not meet one of the therapy mode definitions
below, those minutes may not be counted on the MDS. The therapy mode
definitions must always be followed and apply regardless of when the
therapy is provided in relationship to all assessment windows (i.e., applies
whether or not the resident is in a look-back period for an MDS assessment).

Modes of therapy for Medicare
Part A
• Individual Therapy - The treatment of one resident at a time. The resident
is receiving the therapist’s or the assistant’s full attention .
• Concurrent Therapy - The treatment of 2 residents, who are not performing
the same or similar activities, at the same time, regardless of payer source,
both of whom must be in line-of-sight of the treating therapist or assistant .
• Group Therapy - The treatment of 4 residents, regardless of payer source,
who are performing the same or similar activities, and are supervised by a
therapist or assistant who is not supervising any other individuals.
• Medicare Part B The treatment of two or more residents who may or may
not be performing the same or similar activity, regardless of payer source, at
the same time is documented as group treatment

Section X
• X0570: Optional State Assessment (A0300A/B on existing record to be
modified/inactivated)

Section Z
1/24/2023
The HIPPS code is comprised of the PDPM case mix code,
which is calculated from the assessment data.
The first four positions of the HIPPS code contain the PDPM
classification codes for each PDPM component to be billed for
Medicare reimbursement, followed by an indicator of the type of
assessment that was completed.

Z0100
1/24/2023
• Medicare Part A Billing – HIPPS Code
• Health Insurance Prospective Payment System code is comprised of the PDPM case mix
code, which is calculated from the assessment data.
• The first four positions of the HIPPS code contain the PDPM classification codes for each
PDPM component to be billed for Medicare reimbursement, followed by an indicator of the
type of assessment that was completed.
• Under PDPM,
o the first position represents the Physical Therapy/Occupational Therapy (PT/OT) Payment Group,
o the second position represents the Speech Language Pathology (SLP) Payment Group, t
o the third position represents the Nursing Payment Group,
o the fourth position represents the Non-therapy Ancillary (NTA) Payment Group,
o and the fifth position represents the Assessment Indicator (AI) code indicating which type of
assessment was completed

Review-other-MDS-changes.pptx

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