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Correct order for Skilled Part A top ICD 10 Codes with billing, Triple Check

Lynn Posted Wed 18th of January, 2017 14:01:55 PM
I need a definitive answer on how to list to top 8 to 10 ICD 10 codes for skilled part A Rehab residents. It is my understanding as a MDS nurse the first code should reflect the reason the resident had their most recent hospital stay. Then 3 to 5 therapy codes from the therapies that help treat this resident in connection to the primary diagnosis. Last the top medical diagnosis for the residents. Please advise the correct listing on UB Billing forms and reasons for the specific selections. Also I have heard information like diabetes pays more than hypertension. Should DM or E11.9 be listed prior to HTN or I10? Is there any truth to this? Where did you get this information, please provide sources. R. Graham, RN
SuperCoder Answered Thu 19th of January, 2017 08:52:55 AM

Our experts are working on it. We thank you for your patience.

SuperCoder Answered Thu 19th of January, 2017 08:52:55 AM
Our experts are working on it. We thank you for your patience.
SuperCoder Answered Tue 24th of January, 2017 06:48:24 AM

Greetings from SuperCoder.com!

 

As per ICD-10 CM 2017 Guidelines (Section II-K): “When the purpose for the admission/encounter is rehabilitation, you should sequence first the code for the condition for which the service is being performed.  If the condition for which the rehabilitation service is no longer present, report the appropriate aftercare code as the first-listed or principal diagnosis.”

 

NOTE: The provider should include the principal diagnosis in field 67 of UB-04 form and Additional or secondary diagnoses codes should be included on the current bill in fields 67A-67Q.

 

As per AHIMA: “The first code reported for the principal diagnosis should be (Z51.89 - Encounter for other specified aftercare), which shows the reason for admission was for care involving rehabilitation procedures. The next code reported should be the reason the patient is receiving rehabilitation. This often represents the patient’s impairment (e.g., hemiparesis, quadriparesis, aftercare following joint replacement). Additional codes are reported for comorbidities and complications.

 

A code for an acute condition is only reported if it is still present (e.g., multiple sclerosis) or is being treated (e.g., pneumonia still being treated with antibiotics). Codes are assigned for conditions first identified the day prior to or the day of discharge and for procedures performed during admission to the facility. However, codes are not assigned for conditions that are no longer present or that have been treated prior to admission.

 

The ICD-10-CM codes reported on the UB-04 do not affect Medicare reimbursement. The HIPPS code is reported on the UB-04 and determines the reimbursement for the case.”

 

Sources:

http://library.ahima.org/doc?oid=70673#.WIcsJVN97IU

http://www.hcpro.com/supplemental/medicare_a_special_report.pdf

 

Please feel free to write if you have any concern or questions.

 

Thanks.

SuperCoder Answered Tue 24th of January, 2017 06:48:24 AM
Our experts are working on it. We thank you for your patience.
SuperCoder Answered Wed 25th of January, 2017 02:11:14 AM

Greetings from SuperCoder.com!

 

As per ICD-10 CM 2017 Guidelines (Section II-K): “When the purpose for the admission/encounter is rehabilitation, you should sequence first the code for the condition for which the service is being performed.  If the condition for which the rehabilitation service is no longer present, report the appropriate aftercare code as the first-listed or principal diagnosis.”

 

NOTE: The provider should include the principal diagnosis in field 67 of UB-04 form and Additional or secondary diagnoses codes should be included on the current bill in fields 67A-67Q.

 

As per AHIMA: “The first code reported for the principal diagnosis should be (Z51.89 - Encounter for other specified aftercare), which shows the reason for admission was for care involving rehabilitation procedures. The next code reported should be the reason the patient is receiving rehabilitation. This often represents the patient’s impairment (e.g., hemiparesis, quadriparesis, aftercare following joint replacement). Additional codes are reported for comorbidities and complications.

 

A code for an acute condition is only reported if it is still present (e.g., multiple sclerosis) or is being treated (e.g., pneumonia still being treated with antibiotics). Codes are assigned for conditions first identified the day prior to or the day of discharge and for procedures performed during admission to the facility. However, codes are not assigned for conditions that are no longer present or that have been treated prior to admission.

 

The ICD-10-CM codes reported on the UB-04 do not affect Medicare reimbursement. The HIPPS code is reported on the UB-04 and determines the reimbursement for the case.”

 

Sources:

http://library.ahima.org/doc?oid=70673#.WIcsJVN97IU

http://www.hcpro.com/supplemental/medicare_a_special_report.pdf

 

Please feel free to write if you have any concern or questions.

 

Thanks.

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