ICD-10-CM: The New Focus

There are a lot of questions surrounding ICD-10 so we sat down with our ICD-10 expert, Kelly Schroer and she provided some answers.

What is ICD-10-CM diagnostic coding?

The ICD-10-CM is a classification system published by the United States used for classifying diagnoses and reasons for health care setting visits.  The ICD-10-CM is based on the ICD-10 classification system published by the World Health Organization.

How will ICD-10-CM play a role in the new PDPM payment system?

There are two specific ways for which ICD-10-CM will play a critical role with PDPM.  First, facilities will need to determine, upon admission, the main reason why the resident is in the facility.  This is the primary or principal diagnosis, and this code will map the resident to one of the ten clinical categories.  This category is then used as part of the resident’s classification related to the PT, OT, and SLP components.  Second, ICD-10-CM codes are used to identify additional complications and/or comorbidities which can factor into the SLP component, as well as the NTA (non-therapy ancillary) comorbidity score within the NTA component.

Why is ICD-10-CM coding important?

Accurate diagnosis identification and accurate ICD-10-CM code assignment are very important since the principal or primary diagnosis is a key driver to correct reimbursement under PDPM.  Also, identification of complication and comorbidity diagnoses will impact the SLP and NTA components, which will effect reimbursement. 

What are coding guidelines and conventions, and are they important?

The coding guidelines are a set of rules that have been developed to accompany the official conventions and instructions  within ICD-10-CM.  These guidelines are based on coding and sequencing instructions found in the ICD-10-CM book, but also provide additional instructions for the coder.  Adherence to these coding guidelines when assigning codes is required under HIPAA.

Can I use aftercare Z code as a primary or principal diagnosis?

Yes, aftercare codes are often used, and are appropriate, if that is the primary reason for the SNF admission.

Who in the SNF will play a role in the ICD-10-CM process?

The identification of the principal or primary diagnosis will need to be a team effort.  All disciplines who contribute to the diagnosis documentation should be involved.  This may include MDS, nurses, physicians, therapists, health information management or medical record staff, etc.

Will further training be necessary?

Definitely!  Many coders have never had proper ICD-10-CM training, or have not had training since the implementation of ICD-10-CM in 2015.  Also, with PDPM the coding responsibility may be shifting to another discipline, and this discipline may be inexperienced with the coding process.

Is it important to have a current ICD-10-CM code book?

Yes.  ICD-10-CM codes are updated annually, in October, therefore an outdated code book will not include current acceptable ICD-10-CM codes.

What are the next steps related to ICD-10-CM?

Attending coding education programs is a great start to ensure knowledge of how to properly perform the coding function.  Furthermore, it’s important to start reviewing your current residents’ code assignment to determine which of the ten clinical categories they are mapping to (The mapping crosswalk is available on the CMS website), and whether or not the diagnosis is mapping to the category ‘return to provider’.  If the latter is the case, then review of the medical record by the interdisciplinary team is crucial to determine a more appropriate principal or primary diagnosis for the resident.  Of note, currently many facilities use the reason for therapy as the principal or primary diagnosis (i.e. weakness, muscle weakness, dysphagia, etc.), however many of these diagnoses will map to ‘return to provider’ under PDPM.  

Kelly Schroer, BS, MHA, RHIA, has worked in the acute care and skilled nursing sectors for the past 20 years, as the Director of medical records programs at both the facility and corporate level. She is an ICD-10-CM trainer, and assists facilities with the diagnosis coding processes.