Unraveling the Impact of 2019 Coding Updates on Skilled Nursing Facilities
In the ever-evolving world of healthcare, coding updates are crucial for ensuring accurate billing, patient care documentation, and reimbursement. Among these, the 2019 coding updates have had a significant impact on Skilled Nursing Facilities (SNFs). With an emphasis on precision and detail, these updates necessitate adjustments in the way SNFs handle coding processes. Understanding these changes is vital for administrators, coders, and healthcare providers to maintain compliance, improve operational efficiency, and minimize errors. This article explores the key elements of the 2019 coding updates and their specific implications for SNFs.
The Importance of Coding Updates in Skilled Nursing Facilities
Skilled Nursing Facilities (SNFs) rely on accurate coding to ensure that they receive proper reimbursement from Medicare and other insurers. These codes are also used for statistical tracking, quality reporting, and regulatory compliance. Coding is the process of translating medical diagnoses, treatments, and procedures into standardized alphanumeric codes that are used by healthcare systems. As such, any changes or updates to the coding system can significantly affect how care is documented and reimbursed.
The 2019 coding updates, particularly those under the ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) and the MDS (Minimum Data Set), brought about essential changes that have reshaped how skilled nursing facilities operate. These updates aimed to address gaps in the previous coding structure, improve specificity, and promote more accurate reporting, which in turn improves patient care quality.
Key Aspects of the 2019 Coding Updates That Affect SNFs
The 2019 coding updates introduced several changes that directly impact Skilled Nursing Facilities, from new diagnostic codes to revisions in the Minimum Data Set. Below are the most notable updates:
1. New ICD-10-CM Codes for Specific Conditions
One of the major changes in the 2019 coding updates was the introduction of new ICD-10-CM codes for a variety of specific conditions. These additions enhance the level of detail available for documenting patient conditions, which in turn improves patient outcomes and the accuracy of billing. Some of the key additions include:
- Spinal Disorders: A number of codes were added to more precisely categorize spinal fractures and degenerative disorders.
- Neurological Conditions: Updates to the neurological condition codes were made to reflect the advancements in diagnosing conditions like Parkinson’s disease and Alzheimer’s disease.
- Cardiovascular Diseases: Enhanced codes now allow for more detailed reporting of heart conditions and complications, including arrhythmias and heart failure.
With the introduction of these more specific codes, SNFs are better positioned to provide a more accurate portrayal of the care delivered. Additionally, these updates ensure that SNFs can meet the increasing demand for more precise documentation required by payers like Medicare and Medicaid.
2. The Introduction of New MDS Items
The Minimum Data Set (MDS) is a core assessment tool used in SNFs for evaluating patient health status and determining care needs. The 2019 coding updates included changes to MDS items that impacted both the assessment process and reimbursement. Some of these changes are:
- Section GG Enhancements: Section GG, which deals with functional status, was enhanced with more detailed questions and better clarity. This allows for more accurate reporting of a patient’s functional abilities, which influences reimbursement rates.
- Section I Updates: Changes in Section I, which tracks medical conditions, have led to more precise classifications of chronic conditions, which are used for determining patient acuity.
- Changes to Resident Assessment Protocols: SNFs saw adjustments to the protocols that guide the clinical decision-making process for various diseases, helping to ensure more accurate care planning.
These MDS updates ensure that the data collected about a patient’s condition is more reflective of their actual needs, improving care quality while providing more accurate reimbursement based on the facility’s case mix.
3. ICD-10 Codes for Social Determinants of Health
In 2019, the ICD-10 code set was expanded to include new codes related to social determinants of health (SDOH). These codes are designed to capture non-medical factors that influence health outcomes, such as access to food, safe housing, and socioeconomic status. For SNFs, this change is significant because it allows for the integration of a patient’s living conditions and lifestyle into the care plan. By capturing more comprehensive data about a patient’s social situation, facilities can tailor care plans that better address the holistic needs of patients.
Some examples of the new SDOH codes include:
- Z59.0: Homelessness
- Z60.9: Social environment issue, unspecified
- Z63.5: Disruption of family by separation or divorce
Using these codes accurately helps SNFs to improve patient care by considering the broader factors that might affect recovery and well-being.
Step-by-Step Guide to Adapting to the 2019 Coding Updates in SNFs
To help Skilled Nursing Facilities adapt to these changes, here is a step-by-step guide on how to implement the 2019 coding updates effectively:
Step 1: Review the Updated Coding Guidelines
The first step for any SNF is to review the official coding guidelines issued by CMS (Centers for Medicare & Medicaid Services) and the American Health Information Management Association (AHIMA). This ensures that coders are aware of all the new updates and understand the specific requirements for applying the new codes.
Step 2: Train Coders and Healthcare Staff
Training is crucial to ensure that coders and healthcare staff are familiar with the new coding changes. Offering regular training sessions and workshops will help staff stay current with the updates. This will reduce errors in coding and documentation, ensuring compliance with the new standards.
Step 3: Update EHR Systems
Electronic Health Records (EHR) systems will need to be updated to reflect the new codes and MDS items. Work with your IT team or EHR provider to integrate the 2019 coding updates into your systems. This might include updating software or creating new templates for accurate coding.
Step 4: Implement New Coding and Billing Procedures
Once the systems and staff are trained, SNFs must implement the new procedures for coding and billing. Ensure that coders have access to all the necessary resources, such as updated codebooks and reference materials, to reduce mistakes and streamline the process.
Step 5: Regular Audits and Feedback
Conduct regular audits of your coding processes to identify any issues early on. Providing ongoing feedback to staff will help improve the accuracy and efficiency of coding practices.
Troubleshooting Common Issues with the 2019 Coding Updates
Despite thorough preparation, issues may arise when implementing the 2019 coding updates. Below are some common challenges and troubleshooting tips:
- Issue: Incorrect application of new codes.
Solution: Revisit training materials and ensure that coders are familiar with the nuances of the new coding rules. - Issue: Delays in updating EHR systems.
Solution: Work closely with your IT department to prioritize the updates. Consider using temporary workarounds if necessary. - Issue: Confusion over the application of social determinants of health codes.
Solution: Provide additional training on how to use these codes and consult resources to ensure they are applied correctly.
Conclusion
The 2019 coding updates have had a profound impact on Skilled Nursing Facilities, requiring them to adapt to new codes and procedures in order to maintain compliance and optimize reimbursement. By understanding the specific changes to ICD-10-CM codes, MDS assessments, and the inclusion of social determinants of health, SNFs can improve both their coding accuracy and patient care quality. Adopting these changes may initially require some effort, but with proper training, system updates, and process management, SNFs will be better equipped to thrive in an increasingly complex healthcare landscape.
For more information on coding updates and how they affect healthcare facilities, visit CMS Official Website. For training resources on coding updates, check out this helpful guide.
This article is in the category Guides & Tutorials and created by CodingTips Team