The finding, which was mentioned casually in an interview back in March, ignited a flurry of related debates ever since e. The basic story goes like this:
Because codes on the UB and IRF-PAI do not need to match-and usually do not-and because Medicare fiscal intermediaries have had different interpretations of the ICDCM Official Guidelines for Coding and Reporting in regard to principal diagnosis reporting on the UB, there has been coder confusion and misunderstanding on how to assign these codes.
It was easy to use only 18 items with a seven-part scale and could be completed by any clinician with consistent results. The Uniform Data System for Medical Rehabilitation was established to provide a method of data collection that could be used for research and to improve care for rehabilitation patients.
Additional fields were added to the FIM instrument to capture demographic data and diagnostic information. CMS provides reimbursement for inpatient rehabilitation facilities through case-mix groups. The classification system groups inpatient rehabilitation patients who are expected to use similar resources.
Information collected on the IRF-PAI during the first three days of admission include the impairment, FIM score, and age of the patient, which are used to classify the patient into a case-mix group.
Each case-mix group has four payment tiers. A comorbidity that affects the cost of the rehabilitation admission is assigned to one of the payment tiers based on the cost of the resources to treat the comorbidity.
Payment is based on the highest payment tier reported. Multiple comorbidities assigned to payment tiers do not improve reimbursement. A comorbidity assigned to a payment tier should be sequenced within the first 10 comorbidities so it is reported on the IRF-PAI.
A list of comorbidities assigned to a payment tier can be found on the CMS Web site. This code represents the condition that requires rehabilitation. There are 85 impairment group codes IGCs.
This is the condition responsible for the impairment reported with the IGC. A code for the acute condition responsible for the IGC should be reported. A code for history of the condition or a late effect of the condition is only reported when a prior inpatient rehabilitation program has been completed in an IRF for the same impairment.
ICDCM codes are assigned for conditions that develop or are first discovered after admission to the facility. Complications must be reported as comorbidities to be considered in the assignment of the payment tier. Codes are not assigned for conditions that develop or are first identified the day prior to or the day of discharge.
An IRF is considered a post-acute care facility, and conditions that are treated prior to admission to the IRF are reported with codes that include status post, history of, and late effects.
The first code reported for the principal diagnosis should be from the V The next code reported should be the reason the patient is receiving rehabilitation. Additional codes are reported for comorbidities and complications.
A code for an acute condition is only reported if it is still present e. Codes are assigned for conditions first identified the day prior to or the day of discharge and for procedures performed during admission to the facility.
However, codes are not assigned for conditions that are no longer present or that have been treated prior to admission. InCMS revised this criterion from 10 to 13 conditions and temporarily decreased the percentage that must meet the percent rule and compliance monitoring guidelines.
Currently if these ICDCM codes are reported as a comorbid condition, they will also count as presumptively meeting the rule until July 1, The 75 percent rule poses another challenge for coders because codes assigned to a payment tier and codes listed as meeting the 75 percent rule are not all the same.
Coders should have access to both sets of codes. Challenges for the IRF Coder Coders face a number of challenges coding in an inpatient rehabilitation facility. Current educational opportunities or consultations by a qualified instructor or consultant may be limited, as it is important to understand the coding classification system to provide these services.
The different coding guidelines for different forms can also prove confusing. Conditions reported as acute by a short-term acute care hospital are reported as status post, late effects, et cetera.
This is confusing for coders that code for both an acute care hospital and a rehabilitation unit.
The code reported on the UB as the principal diagnosis, V Documentation can also be an issue. Physician documentation does not always reflect documentation necessary for code assignment or provide information on the impairment or the etiology.
At the same time communication can prove problematic. Communication is necessary so the code for the etiology is consistent with the IGC.
Take for example, a patient who is admitted following a CVA and a hip fracture. Either impairment could be reported by the IGC.
If the hip fracture is reported as the impairment, the etiology should be reported with a code for hip fracture.The Pearl Chapter 2 Questions. STUDY. PLAY. Use two examples of Juana's actions from Chap. 1 and 2 to provide evidence for your opinion on the second question.
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