integrated coding and pdpm 15 case study coding sheet › snf › august2019 ›...

MDS 3.0 1.17.0 | CASE STUDY CODING SHEET | August 14, 2019

Integrated Coding and PDPM Case Study Coding Sheet

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PDPM Calculation Worksheet Responses for Mrs. S

Calculation of PDPM Cognitive Level

Step 1. C0500. BIMS Summary Score________________

PDPM Cognitive Level______________________

Calculation of PT Payment Component

Step 1. I0020B Diagnosis_______________________________________

Default Primary Diagnosis Clinical Category__________________________________

Step 1A. Resident Eligible for Surgical Clinical Catory and Received Major joint replacement or spinal surgery? Yes_____ No_____

Step 1B. Resident Eligible for Surgical Clinical Category and Received Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery)? Yes_____ No_____

Step 1C. Resident Eligible for Surgical Clinical Category and Received Significant Non-Orthopedic Surgical Procedure? Yes_____ No_____

Step 1D. Finalized Primary Diagnosis Clinical Category__________________________________

Step 2. PT Clinical Category_________________________________________________________

Step 3. Calculation of Function Score:

· Self-Care Admission Performance Function Score:

o Eating _____ Oral Hygiene _____ Toileting Hygiene _____

· Mobility Admission Performance Function Score:

o Bed Mobility: Sit to Lying _____ Lying to Sitting _____

o Transfer: Sit to Stand ______ Chair/bed-to-chair transfer _____ Toilet transfer __________

o Walking: Walk 50 feet with two turns _____ Walk 150 feet __________

· Average Bed Mobility ______ Average Transfer ______ Average Walking _____

PDPM PT Function Score _____

Step 4. PDPM PT Classification_____



Calculation of OT Payment Component*

*Note: The steps for calculating the resident’s PDPM classification for the OT component follow thesame logic used for calculating the resident’s PDPM classification for the PT component, described above. Therefore the PDPM OT Classification is the same as the PDPM PT Classification.

PDPM OT Case-Mix Classification _____

Calculation of SLP Payment Component*

*Note: The primary diagnosis clinical category used for the SLP component is the same as the clinicalcategory used for the PT and OT components.

Step 1. Primary Diagnosis Clinical Category _____________________________________

Step 2. SLP Clinical Category ________________________________________________

Step 3. Presence of one or more SLP-related comorbidities? Yes_____ No_____

Step 4. Presence of cognitive impairment? Yes _____ No _____

Step 5. Number of conditions present (based on Steps 2, 3 and 4) __________

Step 6. Presence of Swallowing Disorder? Yes _____ No _____

Step 7. Presence of Mechanically Altered Diet? Yes _____ No _____

Step 8. Presence of Mechanically Altered Diet or Swallowing Disorder? (Neither/Either/Both) __________

Step 9: PDPM SLP Classification __________

Calculation of NTA Payment Component

Step 1. Resident has HIV/AIDS? Yes _____ No _____

Presence of Parenteral/IV Feeding – High Intensity? Yes _____ No _____

Presentce of Parenteral/IV Feeding – Low Intensity? Yes _____ No _____

NTA-related comorbidities (Table 16) __________

Step 2. NTA Score__________

Step 3. PDPM NTA Classification__________



Calculation of Nursing Component

Step 1. Calculation of Function Score:

· Self-Care Admission Performance Function Score:

o Eating _____ Toileting Hygiene _____

· Mobility Admission Performance Function Score:

o Bed Mobility: Sit to Lying _____ Lying to Sitting _____

o Transfer: Sit to Stand ______ Chair/bed-to-chair transfer _____ Toilet transfer __________

· Average Bed Mobility ______ Average Transfer ______

PDPM Nursing Function Score__________

Step 2. Nursing Case-Mix Group ________________________________________

Step 3. Resident Qualifies as Depressed? Yes _____ No _____

Step 4. PDPM Nursing Classification_______________

HIPPS Character 1: PT/OT Component

Clinical Category___________________________________________________

Section GG Function Score__________

PT/OT Case-Mix Group__________

HIPPS Character 1_____

HIPPS Character 2: SLP Component

Presence of Acute Neurologic Condition, SLP-Related Cormorbidity, or Cognitive Impairment (None, Any one, Any two, All three) ___________________________________

Mechanically Altered Diet or Swallowing Disorder (Neither/Either/Both)_______________

SLP Case-Mix Group________




HIPPS Character 3: Nursing Component

RUG-IV Nursing RUG _______

Extensive Services _______

Clinical Conditions ________________________________________________

Depression Yes_____ No_____

Number of Restorative Services ______

GG-based FunctionScore _____

Nursing Case-Mix Group _____


HIPPS Character 4: NTA Component

NTA Score Range _____

NTA Case-Mix Group _____


HIPPS Character 5: AI Code


FINAL HIPPS CODE FOR MRS. S_______________

integrated coding and pdpm 15 case study coding sheet › snf › august2019 ›...

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