The Patient-Driven Payment Model (PDPM) goes into effect October 1, 2019—just six months away. The new model bases reimbursement on the patient’s needs and acuity rather than the volume of services provided.
I.I. Additional surgery HCPCS exclusions: All of the HCPCS listed on the Update File for consolidated billing Category 1 are exclusions, except for minor surgical procedures. Minor surgeries listed on the file are included in SNF consolidated billing and are the responsibility of the SNF. These procedures are considered minor because they may be safely performed either in the physician’s office or in the SNF. Some examples of included minor surgical procedures include toenail debridement, application of certain types of casts, and blood transfusion.
As a member of the Billers’ Association for Long-Term Care, you have access to our talk forum, where billing professionals can ask and answer questions to help each other solve billing and reimbursement challenges. A recent biller brought up a good question: Do you therapists bill the time they participate in the SNF care plan meeting?
New CMP amounts that have been adjusted for inflation and are effective October 11, 2018 were announced in a final rule published by CMS on January 22, 2019. The adjusted amounts apply to CMPs assessed on or after October 11, 2018. For SNFs, NFs and SNF/NFs, the CMP Analytic Tool instructions and calculations will be updated to reflect these changes. Appendix A of the final rule announcement contains the new rates, which have seen an increase.
As coders mark the third anniversary this October of the U.S. implementation of ICD-10, its newly minted successor is waiting in the wings, nearly ready for adoption. That would be the International Classification of Diseases 11th Revision, otherwise known as ICD-11, which was released by the World Health Organization (WHO) in June after a decade in development. And U.S. officials are already considering a switch to the codes—for use on death certificates.
Per the 2018 CPTÒ Manual, nursing facility services are reported using CPT codes 99304–99318. Notice that the heading for this category is Nursing Facility Services rather than Skilled Nursing Facility Services. It would be clearer if the heading was Skilled Nursing Facility Services as these E/M services can be administered to patients in skilled nursing facilities (SNF), intermediate care facilities, psychiatric residential treatment centers, or long-term care facilities.
A revised MLN Matters article regarding updated healthcare common procedure coding system (HCPCS) drug/biological code changes deleted the note that stated MACs should hold claims for HCPCS codes Q5108 and Q5110 until CR10834 is implemented, since that is no longer a requirement. The article was originally released on August 10, 2018 and revised on September 13, 2018.
The National Center for Health Statistics recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, 2018, through September 30, 2019, which include updated language and added specificity for classifying diagnoses. The guidelines include updated language conventions to improve coding accuracy. Per guideline I.C.1.15, “with” or “in” should be interpreted to mean “associated with” or “due to” when they appear in the Alphabetic Index (either under a main term or subterm), a code title, or an instructional note in the Tabular List.