CMS and CDC are updating the ICD-10-CM coding guidelines and codes as of April 1, 2023. There are new codes and codes that will be invalid; therefore, a higher level of specificity is needed to allow the coding of more characters and deleted codes. Updates to the ICD-10-CM coding guidelines must be followed. ICD-10-CM codes impact resident medical records- accurate diagnosis codes are required. ICD-10-CM codes also impact payment. Invalid or deleted codes appearing on UB-04s will cause the claims to be rejected.
In addition to the new guidelines and code changes, this presentation will focus on how to keep the resident medical record diagnoses lists up to date. The process of determining which residents have outdated ICD-10-CM codes on their medical records will be addressed using the April 1, 2023, Conversion Table. Guidance will be provided on how to proceed with updating codes from the documentation by the physician already present in the medical records or the need to query the physician for more specificity for those diagnoses.
The presentation will include how to keep the codes updated at least quarterly by interdisciplinary review of the diagnosis codes when completing MDS assessments and determining which diagnoses will require physician query whether the diagnoses remain active, should be resolved or changed to a personal history code. The necessity for accuracy of diagnosis coding in medical records cannot be overstated.
1. State one diagnosis that has a new ICD-10-CM code that will become effective 4/1/2023.
2. Report one change to the ICD-10-CM coding guideline.
3. Explain how to use the ICD-10-CM Conversion table to identify which residents have codes that will be invalid on 4/1/2023.
Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC
Carol Maher is a Board Certified Gerontological Registered Nurse with over 30 years of long term care experience and has worked in long term care in many roles. She worked as the MDS Coordinator in a 300 bed SNF in Pennsylvania for 8 years before moving to CA to become the MDS Coordinator/Director for a 1200 bed SNF in San Francisco. She has also worked as the MDS Coordinator in a SNF that typically had 60-75 residents on Medicare in addition to 160 long-term care residents. Most recently she was the Senior VP of Utilization Services and Director of Reimbursement for large multi-facility organizations.
Carol has worked as one of the Gold Standard nurses for MDS 3.0, serving on the RAP workgroup to prepare the way for the CAAs for MDS 3.0, and participating on a number of Technical Expert Panels related to MDS, Quality Measures and care planning. A sought-after speaker, she has given presentations at AANAC, AHCA and Leading Age national conferences as well as many state organization presentations. She is also a frequent author of articles related to the RAI process and PPS. Carol served as a member of the AANAC Board of Directors for 9 years. She is presently serving as the chair of the AANAC Expert Advisory Panel and as an AANAC Master Teacher of the RAC-CT and RAC-CTA certification courses. Ms. Maher is the Director of Education for Hansen Hunter & Co. P.C., providing MDS and Medicare classes across the country, presenting monthly educational webinars and completing compliance audits. She is the author of Long-Term Care MDS Coordinator’s Field Guide (HCPRO 2016).
- 1 credit hours for RNs
- 1 credit hours for NABs
This pre-recorded webinar expires on February 24, 2025.