Involve the Interdisciplinary Team. last. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. These conditions, along with the number of points associated with the condition and how it is reported, can be found by downloading the CMS document titled Fact Sheet: NTA Comorbidity Score. endstream endobj 454 0 obj <>stream (difference of NE-NF and NA-NB). |Pa(E8BNJA!-tUiX%:h~GJ?J.H% kZ*qyXjBy@C(zHhzQhhlL2cO`.$p6_[3R^IrHrr6#eq7**2uWytb$HyZi[F2_ GBM*.`k@/9cO9R*^fo_MOK6_xg,eM'jv}5E|SWNH0$z|.WL7y9 ;4H*h;H8H"*RW l? Actually, were going to limit our scope to only I8000 items. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. This information is essential. border: 1px solid black; Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM and the grouper software will pick it up from I8000. In this article, we discuss the non-therapy ancillary (NTA) component. endstream endobj 1696 0 obj <>stream For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. This simply shows you a starting point. Comorbidities associated with higher increases in NTA costs are grouped into higher point tiers, while those that are associated with lower increases in NTA costs are grouped into lower point tiers. b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? THURSDAY JUNE 23, 2022 2 PM EASTERN - 90 MINUTES, OHIO HEALTH CARE ASSOCIATION- Virtual Webinar, COST $35 FOR OHCA MEMBERS, $90 FOR NON-MEMBERS, https://webinars.ohca.org/?pg=semwebCatalog&panel=showLive&seminarid=16339, 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM. Complete a blank sample electronically to save yourself time and money. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. 0000002280 00000 n These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. They are assisted by certified nursing assistants (CNAs) and licensed staff assist them during medication administration ordered by the patients attending physician in the facility. ordered by the patients attending physician in the facility. The general method for calculation of any NTA category is as follows: The Fiscal Year (FY) 2021 PDPM ICD-10-CM Mappings file includes the NTA Comorbidity to ICD-10-CM Mapping, which maps comorbidities in the NTA component captured in item I8000 to allowable ICD-10 codes. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). We earn 1 NTA point for second or third degree burn coded in M1040F. Notice there is a big pocket of low NTA rates that covers most of Iowa. 0000004207 00000 n ~,/-I\!/JfB. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. Five of the six are case-mix adjusted. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer, and toilet transfer assessed on the first three days of admission to the facility with the admission day counted as day 1. Ive done that for urban and rural for every state. Based on that, we can calculate the rate. IV medications provided as a resident and coded in Section O would also qualify for NTA points. Start (and continue) the conversation. 0000002038 00000 n table, th, td { The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023, Osteomyelitis of vertebra, site unspecified, Other acute osteomyelitis, unspecified ankle and foot, Staphylococcal arthritis, unspecified knee, Other acute osteomyelitis, unspecified site, Pneumococcal arthritis, unspecified joint, Other chronic osteomyelitis, unspecified ankle and foot, Other acute osteomyelitis, unspecified tibia and fibula, Other chronic osteomyelitis, unspecified site, Direct infection of unspecified joint in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified hip, Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified shoulder, Other chronic osteomyelitis, unspecified tibia and fibula, Other acute osteomyelitis, unspecified femur, Direct infection of vertebrae in infectious and parasitic diseases classified elsewhere, Other chronic osteomyelitis, unspecified thigh, Direct infection of multiple joints in infectious and parasitic diseases classified elsewhere, Other acute osteomyelitis, multiple sites, Staphylococcal arthritis, unspecified ankle and foot, Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission, Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter, Embolism due to vascular prosthetic devices, implants and grafts, initial encounter, Other mechanical complication of unspecified internal joint prosthesis, initial encounter, Dislocation of unspecified internal joint prosthesis, initial encounter, Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter, Infection and inflammatory reaction due to internal fixation device of unspecified site, initial encounter, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter, Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter, Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter, Breakdown (mechanical) of internal fixation device of unspecified bone of limb, initial encounter, Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter, Mechanical loosening of unspecified internal prosthetic joint, initial encounter, Broken internal joint prosthesis, unspecified site, initial encounter, Embolism due to genitourinary prosthetic devices, implants and grafts, initial encounter, Secondary esophageal varices without bleeding, Secondary esophageal varices with bleeding, Alcoholic cirrhosis of liver without ascites, Antineoplastic chemotherapy induced pancytopenia, Agranulocytosis secondary to cancer chemotherapy, Acute respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic postprocedural respiratory failure, Acute pulmonary insufficiency following thoracic surgery, Acute and subacute infective endocarditis, Acute and subacute endocarditis, unspecified, Endocarditis and heart valve disorders in diseases classified elsewhere, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus, Epilepsy, unspecified, intractable, with status epilepticus, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus, Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus, Respiratory bronchiolitis interstitial lung disease, Respiratory disorders in diseases classified elsewhere, Other alveolar and parieto-alveolar conditions, Idiopathic interstitial pneumonia, not otherwise specified, Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema, Morbid (severe) obesity due to excess calories, Morbid (severe) obesity with alveolar hypoventilation, Body mass index (BMI) 70 or greater, adult, Ulcerative colitis, unspecified, without complications, Crohns disease, unspecified, without complications, Other ulcerative colitis without complications, Ulcerative (chronic) pancolitis without complications, Ulcerative (chronic) proctitis without complications, Crohns disease of small intestine without complications, Crohns disease of large intestine without complications, Idiopathic aseptic necrosis of unspecified femur, Idiopathic aseptic necrosis of unspecified bone, Idiopathic aseptic necrosis of bone, other site, Systemic lupus erythematosus, organ or system involvement unspecified, Ankylosing spondylitis of unspecified sites in spine, Wegeners granulomatosis without renal involvement, Polymyositis, organ involvement unspecified, Dermatopolymyositis, unspecified, organ involvement unspecified, Systemic involvement of connective tissue, unspecified, Unspecified inflammatory spondylopathy, site unspecified, Refractory anemia without ring sideroblasts, so stated, Other specified disorders involving the immune mechanism, not elsewhere classified, Disorder involving the immune mechanism, unspecified. Each component has its case mix index to determine the component rate. Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. We earn 1 NTA point for second or third degree burn coded in M1040F. On any device & OS. At the direction of the attending physician, a patient needs skilled care from and/or under the supervision of a skilled nursing or therapy staff daily. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. Luckily, code diving is a lot of fun, right? Ill also compare urban versus rural facilities when it comes to NTA case-mix. Patient has at least three qualifying inpatient days in an acute hospital. With this component being paid at a 3x rate for 1st 3 days of . Of importance to note is the condition of HIV/AIDS under the NTA component. 0000002742 00000 n These groups and indices, combined with other components of the payment system, provide a total reimbursement process that These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P, The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. Under the PDPM structure, there are no rules regarding when nursing home staff can perform an IPA, McCarthy noted, and even slight changes to a resident's care plan could result in additional NTA points that could bring in extra per-day reimbursement dollars. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. Center for Medicare and Medicaid Services. Holds on recalibrating the PDPM "parity adjustment" that is designed to ensure budget neutrality under the new model to assist SNFs in meeting the demands of the COVID-19 pandemic until FY 2023. It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a step-down facility from an acute hospital stay. Determinants of payment are based on the patients characteristics assigned to six components: Patients are assigned to classification groups known as RUG Classification Groups based on various characteristics of patients and the intensity of therapy services provided. When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score.