It's Heating Up Out There!
Spring may be slow to show but PDPM fun is heating up!
There are now over 100 MDS Coordinators mastering PDPM using the PDPM Grouper by Nicodemus 5‑Star Consulting, LLC. As they are becoming increasingly savvy at finding those missing ICD10s and under-coded areas, several questions have come up:
Multi-Drug Resistant Organisms (MDS item I1700- MDROs)
What are the parameters for coding this item? Does an organism have to have confirmed resistance to multiple drugs? How can we confirm this?
The answer is not as hard as we tend to make it. Although the RAI Manual currently offers little additional guidance, more information is available through the CDC. Officially this is answered as, “Multi-drug resistant organisms (MDROs) are defined as microorganisms, predominantly bacteria, that are resistant to one or more antimicrobial agents, and are usually resistant to all but one or two commercially available antimicrobial agents” (CDC, 2006).
Common examples of MDROs of clinical concern include methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus aureus with resistance to vancomycin (VISA/VRSA), vancomycin-resistant Enterococci (VRE), Penicillin-resistant Streptococcus Pneumoniae (PRSP), extended spectrum beta-lactamase-producing gram-negative bacilli (ESBLs), multi-drug resistant Streptococcus pneumoniae (MDRSP), carbapenem-resistant enterobacteriaceae (CRE), and multi-drug-resistant Acinetobacter. There are others, and unfortunately, there are more coming to be certain. To keep up with the latest MDROs, visit the Centers for Disease Control and Prevention at: https://www.cdc.gov/drugresistance/about.html
Pressure ulcers, Infections, Diabetic Ulcers
The industry has never had any difficulty in getting documentation to be clear about wounds, size, type, location, stage, count, etc. OK, that was sarcasm. Clean up the coffee that you just spit all over your keyboard and move on.
In addition to the fact that good clinical practice would warrant that we clearly identify, describe and monitor wounds, PDPM assigning payment implications to these wounds makes this all the more critical. This is especially true in diabetic patients. While a Stage 4 or unstageable pressure ulcer will count as a point toward your NTA score, any diabetic foot ulcer counts. If the patient has multiple wounds, you could get points for both pressure and diabetic wounds as well – if they are clearly defined. The RAI provides ample guidance on when you must call a wound’s origin pressure versus diabetic or other. Your physicians and wound care personnel need to know how critical this is as well. Remember to be honest though. Nothing makes me cringe like seeing an obvious pressure ulcer coded as something else (MASD, diabetic, etc.) and then the same clinician care-plans these with nothing but pressure-reducing interventions. It’s dishonest and it is obvious.
Foot infections
Is Cellulitis in the foot considered a foot infection? Absolutely, it is right there in the definition of a foot infection in M1040A. More importantly though, is there any wound infected that is not the foot? The NTA portion of PDPM awards two points for I2500 wound infection (other than foot) while only one point toward the foot infection. If the wound(s) spans across the foot and lower leg, code for all the wounds that can be supported individually – these are not mutually exclusive.
ARDs
A revelation that is more apparent when coding real cases in PDPM is that the 5‑day ARD setting has a lot of variables and moving parts. State Medicaid guidelines may affect your decision, such as capturing hospital care for Case Mix. Coding treatments that occurred in your facility or are expected to start may affect your decisions. You got one shot at this for each patient. Knowing the facts of PDPM will help you to make it a well-thought-out decision. However, this is a situation where knowledge is good, but experience is better. Practice!
Remember, in a budget-neutral change like PDPM you want to be on the winning side of that balancing equation. It is not too late to get caught up on all of this fun! Come to one of our trainings, get using the grouper, and get used to PDPM. It will be here before you know it.
We are putting together our next seminar. 8 RN CEUs crammed into a 1‑day PDPM extravaganza! It will be a brutal amount of information, but we will make fun! Be sure to watch for the announcement.
-Mike