This presentation will focus on how to keep the resident medical record diagnoses lists up to date. 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. The necessity for accuracy of diagnosis coding in medical records cannot be overstated.
This presentation will also offer guidance for determining resident diagnoses and diagnosis codes on admission to the nursing home, at least quarterly when the residents’ MDS assessments are completed, and annually when new ICD-10-CM codes are added/updated/deleted. There will be explanations regarding how to use the Conversion Files, the Resident Electronic Health Record Reports, and the Addenda Files for the Alphabetic Index, Tabular List, Neoplasm Table, Tables of Drugs and Chemicals, and External Cause Index to identify codes that are no longer valid, have been deleted or require a higher degree of specificity. The presentation will also explain the correct method to query physicians to obtain more specific diagnoses or to clarify a diagnosis when the documentation has not been clear.
1. Identify which step should be taken when the physician documentation is not clear, or lacks required specificity.
2. Describe how primary diagnoses ICD-10-CM codes on claims can cause claim rejection even though the CMS PDPM file maps the diagnosis to payment.
3. State how the Conversion Table can be used to assist staff to keep resident ICD-10-CM codes up to date.
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).
- 1.25 credit hours for RNs
- 1.25 credit hours for NABs
This pre-recorded webinar expires on March 23, 2025.