PDPM, Non-Therapy Ancillaries & MDS Section I

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PDPM includes a new pay category, the non-therapy ancillary or NTA. Everyone I’ve talked to agrees the NTA payment is a good idea. But, since it’s new, we’re going to have to work on understanding how it’s supposed to work, and how we can most easily and efficiently complete the assessment with accurate information.

Section I has a lot of items that can effect NTA pay.

In this post, we going to look at one important piece of the NTA puzzle, section I.

Actually, we’re going to limit our scope to only I8000 items. Section I of MDS 3.0 is reserved for Active Diagnoses and Item I8000 is you to enter up to 10 additional active diagnoses with corresponding ICD-10 codes.

How should you prioritize your search for ICD-10 codes? Which codes are the most important? Which codes are you most likely to actually see in the wild?

MDS 3.0 Section I – That’s a lot of white space.

A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. In it, you’ll find the 1,612 codes that map to the different comorbidities. Admittedly, that’s a lot to look through. Luckily, code diving is a lot of fun, right?

What if we could limit those codes down to just those ICD-10 codes that are likely to occur. They can’t all be equally likely, right? (At this point, I can feel the cold stares from our MDS Experts. Yes, I am aware that ICD-10 codes do change occasionally. Yes, I’m aware that if you don’t look at every. last. code. you could miss something. Yes, I get that is bad. You should understand those things too, reader.)

Hopefully I don’t lose my blogging privileges, but… I looked at a year’s worth of Part A admissions to every SNF in the country and found, gasp, not all codes occur that often. Some didn’t occur at all.

Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. Click the comorbidity and see the ICD-10 codes that are most likely to occur. (I did abbreviate a few of the names for sanity.) Remember, the CMS list is authoritative, mine is only for your convenience.


Lung Transplant

ICD-10 Description Prevalence
Z942 Lung transplant status 0.01%

Bone/Joint/Muscle

ICD-10 Description Prevalence
M869 Osteomyelitis, unspecified 0.60%
M4620 Osteomyelitis of vertebra, site unspecified 0.15%
M86179 Other acute osteomyelitis, unspecified ankle and foot 0.14%
M8618 Other acute osteomyelitis, other site 0.11%
M00069 Staphylococcal arthritis, unspecified knee 0.08%
M8610 Other acute osteomyelitis, unspecified site 0.08%
M726 Necrotizing fasciitis 0.04%
M0010 Pneumococcal arthritis, unspecified joint 0.04%
M86679 Other chronic osteomyelitis, unspecified ankle and foot 0.04%
M86169 Other acute osteomyelitis, unspecified tibia and fibula 0.04%
M8660 Other chronic osteomyelitis, unspecified site 0.03%
M8668 Other chronic osteomyelitis, other site 0.02%
M01X0 Direct infection of unspecified joint in infectious and parasitic diseases classified elsewhere 0.02%
M00059 Staphylococcal arthritis, unspecified hip 0.02%
M01X69 Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere 0.02%
M00019 Staphylococcal arthritis, unspecified shoulder 0.02%
M0008 Staphylococcal arthritis, vertebrae 0.01%
M86669 Other chronic osteomyelitis, unspecified tibia and fibula 0.01%
M86159 Other acute osteomyelitis, unspecified femur 0.01%
M01X8 Direct infection of vertebrae in infectious and parasitic diseases classified elsewhere 0.01%
M86659 Other chronic osteomyelitis, unspecified thigh 0.01%
M01X9 Direct infection of multiple joints in infectious and parasitic diseases classified elsewhere 0.01%
M8619 Other acute osteomyelitis, multiple sites 0.01%
M00079 Staphylococcal arthritis, unspecified ankle and foot 0.01%

Chronic Myloid Leukemia

ICD-10 Description Prevalence
C9210 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission 0.03%

Opportunistic Infections

ICD-10 Description Prevalence
B3781 Candidal esophagitis 0.04%
B488 Other specified mycoses 0.04%
B449 Aspergillosis, unspecified 0.01%
B371 Pulmonary candidiasis 0.01%
B59 Pneumocystosis 0.01%

Proliferative Diabetic Retinopathy

ICD-10 Description Prevalence
E11359 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema 0.01%

Severe Skin Burns or Condition

ICD-10 Description Prevalence
L511 Stevens-Johnson syndrome 0.01%

Complications of Specified Implanted Device or Graft

ICD-10 Description Prevalence
T8450XA Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter 0.15%
T8481XA Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter 0.05%
T82818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter 0.04%
T84099A Other mechanical complication of unspecified internal joint prosthesis, initial encounter 0.04%
T84029A Dislocation of unspecified internal joint prosthesis, initial encounter 0.03%
T8579XA Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter 0.03%
T8460XA Infection and inflammatory reaction due to internal fixation device of unspecified site, initial encounter 0.02%
T827XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter 0.02%
T82390A Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter 0.02%
T84498A Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter 0.02%
T84119A Breakdown (mechanical) of internal fixation device of unspecified bone of limb, initial encounter 0.02%
T826XXA Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter 0.02%
T84039A Mechanical loosening of unspecified internal prosthetic joint, initial encounter 0.02%
T84019A Broken internal joint prosthesis, unspecified site, initial encounter 0.01%
T8381XA Embolism due to genitourinary prosthetic devices, implants and grafts, initial encounter 0.01%

End-Stage Liver Disease

ICD-10 Description Prevalence
K7210 Chronic hepatic failure without coma 0.07%
K766 Portal hypertension 0.05%
I8500 Esophageal varices without bleeding 0.04%
I8501 Esophageal varices with bleeding 0.02%
I8510 Secondary esophageal varices without bleeding 0.01%
K767 Hepatorenal syndrome 0.01%
I8511 Secondary esophageal varices with bleeding 0.01%

Cirrhosis of Liver

ICD-10 Description Prevalence
K7030 Alcoholic cirrhosis of liver without ascites 0.28%
K709 Alcoholic liver disease, unspecified 0.03%
K743 Primary biliary cirrhosis 0.03%

Disorders of Immunity – Except Immune Disorders?

ICD-10 Description Prevalence
D61818 Other pancytopenia 0.21%
D709 Neutropenia, unspecified 0.07%
D61810 Antineoplastic chemotherapy induced pancytopenia 0.03%
D701 Agranulocytosis secondary to cancer chemotherapy 0.01%
D708 Other neutropenia 0.01%
D61811 Other drug-induced pancytopenia 0.01%

Respiratory Arrest

ICD-10 Description Prevalence
R092 Respiratory arrest 0.02%

Cardio-Respiratory Failure and Shock

ICD-10 Description Prevalence
J9600 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia 2.55%
J9620 Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia 0.86%
J9610 Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia 0.76%
J80 Acute respiratory distress syndrome 0.14%
J810 Acute pulmonary edema 0.13%
I469 Cardiac arrest, cause unspecified 0.11%
I4901 Ventricular fibrillation 0.06%
J95821 Acute postprocedural respiratory failure 0.05%
R570 Cardiogenic shock 0.03%
R579 Shock, unspecified 0.02%
J95822 Acute and chronic postprocedural respiratory failure 0.02%
J951 Acute pulmonary insufficiency following thoracic surgery 0.01%

Endocarditis

ICD-10 Description Prevalence
I38 Endocarditis, valve unspecified 0.19%
I330 Acute and subacute infective endocarditis 0.06%
I339 Acute and subacute endocarditis, unspecified 0.02%
I39 Endocarditis and heart valve disorders in diseases classified elsewhere 0.01%

Intractable Epilepsy

ICD-10 Description Prevalence
G40111 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus 0.04%
G40911 Epilepsy, unspecified, intractable, with status epilepticus 0.03%
G40211 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus 0.01%
G40311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus 0.01%

Pulmonary Fibrosis and Other Chronic Lung Disorders

ICD-10 Description Prevalence
J8410 Pulmonary fibrosis, unspecified 0.35%
J84112 Idiopathic pulmonary fibrosis 0.10%
J479 Bronchiectasis, uncomplicated 0.08%
J471 Bronchiectasis with (acute) exacerbation 0.04%
J84115 Respiratory bronchiolitis interstitial lung disease 0.02%
J99 Respiratory disorders in diseases classified elsewhere 0.01%
J8409 Other alveolar and parieto-alveolar conditions 0.01%
J84111 Idiopathic interstitial pneumonia, not otherwise specified 0.01%
J84114 Acute interstitial pneumonitis 0.01%

Diabetic Retinopathy – Except Proliferative Diabetic Retinopathy and Vitreous Hemorrhage

ICD-10 Description Prevalence
E11311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema 0.16%
E11319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema 0.13%
E10311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema 0.01%
E11329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema 0.01%
E08311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema 0.01%

Narcolepsy and Cataplexy

ICD-10 Description Prevalence
G47419 Narcolepsy without cataplexy 0.03%

Specified Hereditary Metabolic/Immune Disorders

ICD-10 Description Prevalence
E8801 Alpha-1-antitrypsin deficiency 0.01%

Morbid Obesity

ICD-10 Description Prevalence
E6601 Morbid (severe) obesity due to excess calories 1.39%
Z6841 Body mass index (BMI) 40.0-44.9, adult 0.10%
E662 Morbid (severe) obesity with alveolar hypoventilation 0.08%
Z6842 Body mass index (BMI) 45.0-49.9, adult 0.06%
Z6843 Body mass index (BMI) 50-59.9 , adult 0.04%
Z6844 Body mass index (BMI) 60.0-69.9, adult 0.01%
Z6845 Body mass index (BMI) 70 or greater, adult 0.01%

Chronic Pancreatitis

ICD-10 Description Prevalence
K861 Other chronic pancreatitis 0.17%

Inflammatory Bowel Disease

ICD-10 Description Prevalence
K5190 Ulcerative colitis, unspecified, without complications 0.21%
K5090 Crohn’s disease, unspecified, without complications 0.17%
K5180 Other ulcerative colitis without complications 0.06%
K5100 Ulcerative (chronic) pancolitis without complications 0.01%
K5120 Ulcerative (chronic) proctitis without complications 0.01%
K5000 Crohn’s disease of small intestine without complications 0.01%
K5010 Crohn’s disease of large intestine without complications 0.01%

Aseptic Necrosis of Bone

ICD-10 Description Prevalence
M87059 Idiopathic aseptic necrosis of unspecified femur 0.05%
M8700 Idiopathic aseptic necrosis of unspecified bone 0.04%
M8708 Idiopathic aseptic necrosis of bone, other site 0.01%

Psoriatic Arthropathy and Systemic Sclerosis

ICD-10 Description Prevalence
L4054 Psoriatic juvenile arthropathy 0.04%
M340 Progressive systemic sclerosis 0.03%

Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory Spondylopathies

ICD-10 Description Prevalence
M3210 Systemic lupus erythematosus, organ or system involvement unspecified 0.18%
M3500 Sicca syndrome, unspecified 0.07%
M316 Other giant cell arteritis 0.06%
M459 Ankylosing spondylitis of unspecified sites in spine 0.03%
M3130 Wegener’s granulomatosis without renal involvement 0.02%
M3320 Polymyositis, organ involvement unspecified 0.02%
M461 Sacroiliitis, not elsewhere classified 0.01%
M3390 Dermatopolymyositis, unspecified, organ involvement unspecified 0.01%
M359 Systemic involvement of connective tissue, unspecified 0.01%
M4690 Unspecified inflammatory spondylopathy, site unspecified 0.01%
M310 Hypersensitivity angiitis 0.01%

Myelodysplastic Syndromes and Myelofibrosis

ICD-10 Description Prevalence
D469 Myelodysplastic syndrome, unspecified 0.20%
D474 Osteomyelofibrosis 0.03%
D7581 Myelofibrosis 0.02%
D460 Refractory anemia without ring sideroblasts, so stated 0.01%

Immune Disorders

ICD-10 Description Prevalence
D849 Immunodeficiency, unspecified 0.01%
D801 Nonfamilial hypogammaglobulinemia 0.01%
D8989 Other specified disorders involving the immune mechanism, not elsewhere classified 0.01%
D899 Disorder involving the immune mechanism, unspecified 0.01%