01.04.20 | Noreen Hiltsley

CMS Updates PDPM-ICD-10 Mappings for COVID-19

The Centers for Medicare & Medicaid Services (CMS) has the authority to update the list of ICD-10-CM codes used for capturing various payment components under PDPM. CMS has exercised this authority and has released an update of the PDPM DLL Package (V1.0004 FINAL). This update adds support for the new ICD-10-CM code for Coronavirus, U07.1, which takes effect April 1, 2020. 

The new ICD-10-CM code for Coronavirus, U07.1, has been added to the list of acceptable codes that can be used in section I0020b of the MDS to indicate the resident’s primary reason for the Medicare Part A stay. Of significance for skilled nursing facility providers and MDS coordinators, the Coronavirus ICD-10-CM U07.1 will impact the case-mix adjusted components of PDPM as follows:

·    PT/OT: Qualify a patient for the Medical Management clinical category
·    SLP: Qualify a patient for the Non-Neurologic clinical category 
·    Nursing: The diagnosis itself does not have a direct impact to qualify a patient for any of the nursing case-mix groups, but the clinical characteristics and associated services related to a patient with Coronavirus will certainly influence nursing capture
·    NTA: The diagnosis does not currently qualify for any NTA points or additional NTA reimbursement

The Coronavirus ICD-10-CM code can be used on MDS’ with a target date of 04/01/2020 or later.
To download the ZIP file on the CMS updated FY2020 PDPM IDC-10 Mappings click here.
Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for a thorough understanding on practices and procedures. If you have any questions, please contact Matt Nash, Vice President of Strategic Development at: mnash@preftherapy.com