PDPM Pitfalls

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Consider these common scenarios and how your team might better address these areas of potential missed opportunity:

  • Section I: Check Box vs I8000 (ICD-10 code)
    • Not coding diagnoses in the proper location can impact nursing, NTA and SLP components of PDPM
    • For example, respiratory failure should be coded both in the check box I6300 (to support the nursing component) and listed in I8000 (to capture 1 NTA point).
    • Also: check box for aphasia in I4300 will score points for SLP comorbidity, while coding the ICD-10 code for aphasia in I8000 will not.
  • Not being strategic with ARD selection
    • There is often potential to capture IV fluids from the hospital if the ARD is scheduled early within the stay – doing so places the resident into Special Care High for the nursing component.
  • Not taking advantage of the full 3-day look back for coding Section GG
    • One point can make the difference between capturing a TL and a TK
  • Missing the capture of cognitive impairment or depression by 1 point
    • Consider re-administering BIMS interview at an alternate time of day, especially when there is an underlying cognitive diagnosis (ie. Dementia)
    • Consider use of probing questions/breaking the questions into components when administering the PHQ-9 to be sure all potential symptoms and severity are captured
      • Ie. Instead of “Do you have trouble falling or staying asleep, or sleeping too much?” ask in 3 parts, “do you have trouble falling asleep?” “Do you have trouble staying asleep?” “Do you feel you are sleeping too much?”
      • A resident may be more likely to say yes when they are only experiencing one symptom if the question is broken into components.
  • Query the physician early when potential PDPM-reimbursable diagnoses are identified (ie. Malnutrition/at risk for malnutrition) so that they can include the diagnosis in their documentation.

If you’d like assistance, please reach out so we can make arrangements for a brief call to see how we can assist you.


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