Upcoming ICD-10CM changes, set to take effect on October 1, will have a significant impact on skilled nursing facilities, with changes related to Parkinson’s disease being of particular importance.
ICD-10CM codes, the backbone of medical coding, have undergone a consistent evolution since 2021. Notable revisions have been implemented twice annually, with substantial updates aligning each October.
These transformations hold immense significance for skilled nursing operators, as they influence coding accuracy, reimbursement, and overall patient care decisions.
There are quite a few code changes this year, and the changes to the Parkinson’s disease code will have the biggest effect on the SNF setting long-term care sector, according to Jennifer LaBay, a registered nurse and curriculum development specialist with the American Association of Post Acute Care Nursing (AAPACN).
“It went from one code that encompassed everything, including Parkinsonism and the different types of Parkinson’s disease,” LaBay told Skilled Nursing News. “Now, it splits into three separate codes that will delineate the different types of Parkinson’s. So we have a split between Parkinson’s disease without dyskinesia, Parkinson’s disease with dyskinesia, and an unspecified Parkinsonism.”
The refined classifications, LaBay said, are as follows: Parkinson’s disease without dyskinesia, Parkinson’s disease with dyskinesia, and unspecified Parkinsonism.
The importance of precise documentation
LaBay emphasized the pivotal role of meticulous documentation in the medical record. For instance, in the context of Parkinson’s disease diagnoses, accurate documentation by a physician or an advanced practice practitioner is paramount to ascertain the presence or absence of dyskinesia.
This documented accuracy ensures that skilled nursing facilities can seamlessly transition to the new “not otherwise specified” diagnosis (G20.A1) where necessary, she said.
“If there is no documentation specifying dyskinesia, the facility would have to change those codes to the new ‘not otherwise specified’ diagnosis for Parkinson’s disease, which is Parkinson’s disease without dyskinesia, without mention of fluctuations, coded as G20.A1. So it’s a multi-step process,” she said. “You have to look at the resident’s current code, adjust it to the new code, and have supporting information in the medical record for the specific code.”
A conscientious process safeguards the alignment between diagnoses and codes, forming a solid foundation for robust patient care and maintaining payment accuracy, she said.
Coders at the helm
Unquestionably, LaBay said, the success of these code changes hinges on the competence of facility coders, often shouldered by the nurse assessment coordinator.
While extensive training might not be imperative for these changes, she stressed the indispensability of maintaining up-to-date coding manuals.
“It’s a multi-step process,” she said. “You have to look at the resident’s current code, adjust it to the new code, and have supporting information in the medical record for the specific code.”
LaBay said the coder must review the outdated codes, review the medical record for documentation from the physician, and then update the codes with an October 1 effective date in the EHR.
“There doesn’t necessarily need to be extensive training for codes like this,” she said. “The changes will automatically reflect in the electronic health record. But for paper records, a review of the medical record is necessary to adjust the codes.”
Preparing for changes
LaBay advised skilled nursing operators to proactively embrace the changes that lie ahead.
Ensuring annual updates to coding manuals is imperative, as codes and guidelines continue to evolve, she said. She emphasized vigilance by monitoring the CMS ICD-10 pages, as interim updates beyond the annual October releases have become a norm since 2021.
“Accurate ICD-10 coding is crucial for the plan of care; without the right diagnosis, the care plan won’t be appropriate,” she said. “From a PDPM and payment perspective, ICD-10 coding impacts the principal diagnosis selection in I0020B on the MDS. This assigns the clinical category for PT [physical therapy] and OT [occupational therapy] components and potentially affects the speech component.”
LaBay added that coding from I0100 to I8000 of ICD-10 significantly impacts PDPM for operators as well.
“[Coding changes] significantly impacts payments under Medicare and many states even if they use legacy programs,” she said.
October is set to be a big month for skilled nursing facilities. Along with changes to ICD-10 coding, CMS is introducing changes to the MDS. These include significant changes regarding medication coding related to certain high-risk drugs, as just one example of coming updates.
These changes to MDS are focusing on specific medications, including antipsychotics, anti-anxiety medications, antidepressants, hypnotics, anticoagulant antibiotics and opioids. And, the new modifications will require training of nurses and a shift in methods used to record, for example, indications of use for these medications, according to experts and nurses affiliated with nursing homes.
Some clinical staff even recommend templates for verifying the medication order details to avoid scrutiny by surveyors.
“Sometimes the resident may have been on that particular medication for quite a long time, and that may have gotten lost in the shuffle from one provider to another, but it’s very important to dig in now,” Wendy Strain, director of consulting services at Polaris Group, told Skilled Nursing News. “One of the first things we recommend our outsourced MDS coordinators do now and not wait until the last minute is for those because we’re investing in communication with the provider.”
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