PDPM and COVID-19: Nursing Considerations
With the recent spikes in COVID-19 cases across several states, nursing home providers are faced with unprecedented challenges when it comes to caring for residents throughout the pandemic. From inflated PPE costs, staffing shortages/ wage expenses, and new focused survey and staff clinical competencies, to name a few, COVID-19 has placed a huge financial burden on SNF operators paired with an overall national decline in SNF admissions. Review the recent report from Skilled Nursing News regarding admissions.
With staff’s focus on keeping residents safe and healthy, newly acquired PDPM processes and procedures to support optimal coding and reimbursement may have become increasingly difficult to maintain. MDS and nursing staff may be needed on the floor instead of attending previously scheduled clinical meetings. With the increased costs associated with caring for residents with COVID-19, now more than ever, it is essential that providers are accurately coding and documenting the care and services that are being provided to ensure optimal reimbursement.
One major area of opportunity with COVID-19 reimbursement is the coding accuracy of nursing services provided. The following offers a brief review of the PDPM RUG-IV Case Mix Group as it relates to COVID-19:
- Extensive Services: If a resident is on isolation or quarantined for active infectious disease:
- The resident must have tested positive and or is symptomatic awaiting test results.
- Single room isolation is required (NO cohorting allowed).
- Documentation must reflect that all services are being provided in the resident’s room.
- Remember, isolation has a 14 day look back (in PDPM- usually looking at the five days or IPA) and can be coded no matter the number of days in isolation.
**If cohorting COVID-19 residents, other options include:
- Special Care High: Common conditions associated with COVID-19
- Comorbidity of COPD AND documented shortness of breath/difficulty breathing while lying flat (frequently missed opportunity across facilities)
- Fever AND one of the following
- Pneumonia (PNA)- active PNA diagnosis frequently occurs with COVID
- Weight loss -100.4 degrees or 2.4 degrees from the resident’s baseline temperature – need accurate documentation.
- Respiratory therapy for all seven days – 15 minutes provided for all seven days, ensure services are documented and captured by either nursing and or respiratory therapy.
- Special Care Low
- Respiratory failure and oxygen therapy: One major issue with capturing the special care low, if MDS codes respiratory failure with hypoxia as the primary diagnosis, J96.11, which is placed in I20B, and does not check it off in I6300 on the MDS, section I respiratory failure, it will not capture the special care low. It has to be placed in both sections on the MDS to count.
Amidst this national crisis, Synergy Care Inc, an affiliate of the Broussard Group, holds ourselves accountable to our customers, patients and others we serve. After all, we are all in this together.
We hope these resources are beneficial to your organization. If you have any questions or would like some additional information, please contact Synergy Care Inc.