Code Encounters

Does reading the November 12, 2019 released calendar year 2020 Federal Register OPPS final rule somehow not make it to your list of “things to do”? If not, join the masses but you might have missed key information that will put your organization at a disadvantage or loss of revenue.

Reasons why most skilled nursing settings need coding assistance are abundantly clear. Even the most experienced MDS Coordinator or a staff member who has become coding certified in the last year may not understand the minutiae of the code and the magnitude of coding to reimbursement and survey outcomes. Here’s a short list of potential errors to consider:

Whether you are a MDS Coordinator intensifying your knowledge of ICD-10s or a Coder training in skilled nursing services, SNFs and PPS swing bed programs are tasked with “perfection” on October 1. The Patient-Driven Payment Model (PDPM) demands discipline specific coding that captures the need to be inpatient and the care being provided each resident.

The “code first” note is your hint that two codes may be needed, along with sequencing direction. The “code first” note is an instructional note.

If you see “in diseases classified elsewhere” terminology you will assign two codes, with the manifestation code being sequenced after the underlying condition. The “in diseases classified elsewhere” (manifestation) code is actually part of the code title. The code with “in diseases classified elsewhere” documented can never be used as a principal diagnosis.

There can be confusion on how to report lateral- LT/RT and bilateral modifiers-50.

Coders report many of these incorrect or miss reporting altogether.