by Proactive Medical Review | Aug 17, 2022 | ICD.10, Q&A
Q: We have a claim denial from a commercial insurance plan that references their policy related to Excludes 1 Notes based on the ICD10 Official Guidelines for Coding & Reporting. OT and PT used codes R26.2 (difficulty in walking) and R26.81 (unsteadiness on feet)...
by Proactive Medical Review | Aug 3, 2022 | blog, CMS, ICD.10, PDPM
On July 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY)...
by Proactive Medical Review | Jan 26, 2022 | blog, ICD.10, PDPM
Since the inception of PDPM, selecting the Primary Diagnosis has been a challenge for MDS/RAI coordinators. Under PDPM, the diagnosis coded on the 5-day/Initial Minimum Data Set (MDS) in section I0020B largely determines reimbursement for the entire Medicare stay...
by Proactive Medical Review | Jun 30, 2021 | Coding, ICD.10, Q&A
Q: How do I appropriately code a periprosthetic fracture? Should I use an M or S ICD-10 code? A: Fractures result from trauma or injury or a pathological condition. With a periprosthetic fracture, two ICD-10 codes would be utilized. One code would include the...
by Proactive Medical Review | Dec 15, 2020 | blog, ICD.10, PDPM
Diagnosis coding accuracy is paramount to appropriate payment under PDPM, as ICD-10 Diagnosis codes & other patient characteristics are used as the basis for classification in determining Medicare (MCR) payment. The 5-day/Initial MDS establishes the PDPM payment...
by Proactive Medical Review | May 21, 2020 | Audits, blog, Coding, COVID-19, Education, ICD.10, MDS
Q: What is the #1 ICD.10 coding error that you find in your audits? A: Answer: The coding error seen most often is using acute conditions/diagnoses. The RAI Manual states while certain conditions represent acute diagnoses, SNFs should not use acute diagnosis...
