Beginning, October 1, 2020, MDS version 1.17.2 will be instituted. Updates include assessment changes that will support the calculation of PDPM payment codes for state Medicaid programs and on OBRA assessments when not combined with the 5-day SNF PPS assessment.
This will specifically affect the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1.
Sections GG, I, and J
The updated item sets will not have a revised RAI manual released. As of 9/18/2020, AANAC is reporting 31 states have indicated they will be gathering PDPM data for state Medicaid programs and on OBRA assessments.
Items GG0130 and GG0170 headers updated to read “Start of SNF stay or State PDPM”
Completion instructions include: If state requires completion with an OBRA assessment, the assessment period is the ARD plus 2 previous days. Complete only column 1.
Item I0020 instructions for completion are revised: Complete only if A0310B=01 or if state requires completion with an OBRA assessment.
Item J2100 instructions for completion are revised: Complete only if A0310B=01 or if state requires completion with an OBRA assessment.
A new DRAFT version of the 2019 MDS item sets (v1.17.0) , which is scheduled to take effect on October 1, 2019, was posted earlier this month to the MDS technical information webpage . The files are located in the Downloads section at the bottom of the webpage (see MDS 3.0 Item Sets v1.17.0 (DRAFT) for October 1, 2019 Release [ZIP, 3MB] ). This early draft is promising of more information to come. Reliant is monitoring CMS’ updates and postings for more information regarding October 2019 MDS and RAI changes.
Last month we proceeded with our series which dives into critical elements of PDPM by looking at ICD-10 coding. Due to updates provided by CMS we will take one more look at ICD-10 processes for PDPM.
During the open door forum on 11/29/2018, CMS validated information on the PDPM webpage indicating a new MDS item set will be active on October 1, 2019 which will guide the clinical category mapping for the resident. According to CMS’ training materials, new item set I0020B “What is the main reason this person is being admitted to the SNF?” allows for the primary SNF diagnosis to be entered when the response to I0020 “Indicate the resident’s primary medical condition category” is identified as 01-13. The training also provides detailed information about the new items for recording the patient’s surgical history using J2100-J5000. (As of 11/29/2018 CMS notes an error on the PDPM webpage resource New MDS Items which records I0020 as I0200).
It’s important to recognize that although this new item set replaces 18000A as the primary diagnosis mapping line, the codes entered in I8000 and identified throughout section I still require critical thinking and accuracy to ensure accurate reimbursement as these areas contribute directly to SLP comorbidities and conditions, nursing conditions and the non-therapy ancillary comorbidity score.
Current data collection (2018 4th quarter) includes new section GG items added on October 1, 2018. Download Reliant’s resource here .CMS recommends that providers run applicable validation/analysis reports prior to each quarterly reporting deadline in order to ensure all required data has been submitted.