PDPM Clinical Update JWB - VHCA

And you shall rise and show respect to the aged

PDPM Clinical Update One Month In Nov 2019

Judy Wilhide Brandt, RN, BA, CPC, QCP, RAC-MT, DNS-CT 909-800-9124 judy@

Facebook: /WilhideConsulting

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Objectives

? Review the clinical components of the PDPM rate to discussion lessons learned so far

? Discuss strategic ARD setting ? Examine the interrupted stay ? Factors to consider in IPA ? Discuss findings from review of initial IPA and 5 day

submissions from around the country

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Primary Diagnosis Clinical Category Findings

? MD documentation of diagnosis is specific and supported, but ICD 10 code assigned is incorrect.

? Reasons:

? Failure to follow ICD 10 coding guidelines ? Relying on software scrubbers to direct coding

? Primary Diagnosis documented in chart, but not selected as primary.

? Reasons:

? Software scrubber directs to another code that is not the primary

? Misunderstanding of what can be used as primary

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Primary Diagnosis Clinical Category Findings

? Using MD documented diagnoses that are flat out wrong

? Reasons:

? Believing the MD documentation, e.g "morbid obesity"

pasted from a "past history" dx list when resident is 5'2" and 102 lbs. ? MD documentation is not supported by clinical record and MD is not queried. E.g "viral pneumonia" with labs that clearly show S. pneumoniae bacteria

? Ineffectively dealing with return to provider primary diagnoses

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Incorrect use of the Z47.- series of ICD 10 codes

Z47 Orthopedic aftercare ? Excludes1: aftercare for healing fracture-code to

fracture with 7th character D

? Z47.1 Aftercare following joint replacement surgery

? Use additional code to identify the joint (Z96.6-)

? Z47.2 Encounter for removal of internal fixation device

? Excludes1:

? encounter for adjustment of internal fixation device for fracture treatment- code to fracture with appropriate 7th character;

? encounter for removal of external fixation device- code to fracture with 7th character D

? infection or inflammatory reaction to internal fixation device (T84.6-) ? mechanical complication of internal fixation device (T84.1-)

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Z47- Continued

? Z47.3 Aftercare following explantation of joint prosthesis

? Aftercare following explantation of joint prosthesis, staged procedure

? Encounter for joint prosthesis insertion following prior explantation of joint prosthesis

? Z47.31 Aftercare following explantation of shoulder joint prosthesis ? Excludes1: ? acquired absence of shoulder joint following prior explantation of shoulder joint prosthesis(Z89.23-) ? shoulder joint prosthesis explantation status (Z89.23-)

? Z47.32 Aftercare following explantation of hip joint prosthesis ? Excludes1: ? acquired absence of hip joint following prior explantation of hip joint prosthesis (Z89.62-) ? hip joint prosthesis explantation status (Z89.62-)

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Z47.- Continued

? Z47.33 Aftercare following explantation of knee joint prosthesis ? Excludes1:

? acquired absence of knee joint following prior explantation of knee prosthesis (Z89.52-

? knee joint prosthesis explantation status (Z89.52-)

? Z47.8 Encounter for other orthopedic aftercare

? Z47.81 Encounter for orthopedic aftercare following surgical amputation

? Use additional code to identify the limb amputated (Z89.-)

? Z47.82 Encounter for orthopedic aftercare following scoliosis surgery

? Z47.89 Encounter for other orthopedic aftercare

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Excludes1 NOT CODED HERE. Excluded code(s) should never be used at the same time as the code above the "Excludes1" note. Excludes2 Not included here. Condition is not part of the condition represented by the code, but patient may have both at the same time.

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Example:

? Hip replacement due to DJD: Z47.1 ? Hip replacement due to fall and fracture: S72.xxxD

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Incorrect ICD 10 code examples

? I0020B: B00.1 Herpesviral vesicular dermatitis ? Code supported by MD documentation: B00.4

herpesviral encephalitis ? System failure: Coder using dropdown box in MDS

software to assign ICD 10 code without a coding book, saw herpesvir..... And clicked one.

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