Q: I am struggling to select the most appropriate primary diagnosis at I0020 of the MDS for skilled Medicare Part A residents. Is there a way to do this efficiently?
A: The best way to select the primary diagnosis is through a team approach. The interdisciplinary team should have daily meetings to discuss new admissions and select their primary diagnosis.
That selection must be done early in a patient’s stay so the 5-day PPS assessment includes the most accurate primary diagnosis. To qualify, the diagnosis must be documented by a physician/NPP during the 7-day look-back, and ICD-10 coding guidance must be followed. You cannot use documentation after the assessment reference date (ARD) to set the diagnosis.
If the diagnosis is not documented, someone from the IDT must obtain documentation from the physician/NPP before the ARD of the 5-day PPS assessment.
The team’s decisions must be driven by the primary need for skilled care. This may or may not be the reason the resident was initially hospitalized. For example, a resident had hemiplegia from a stroke three years ago and was hospitalized with a urinary tract infection. During the qualifying hospital stay, physical therapy provided treatment for the residual effects of the stroke. Upon SNF admission, the UTI was resolving and was being treated with antibiotics, but the resident continued to have functional impairments related to the hemiplegia. The team agreed that the hemiplegia and daily physical therapy now required the most skilled care.
Lastly, ensure the medical records contain documentation indicating how and why the primary diagnosis was selected. In the event of an audit, this information is crucial to demonstrate that the primary diagnosis was appropriate.
From the July/August 2022 Issue of McKnight's Long-Term Care News
