CMS has released the much anticipated DRAFT version of the 2019 MDS item sets (v.1.17.0), which is scheduled to take effect on October 1, 2019. The DRAFT 2019 MDS item set gives some clarity and insight into some of the changes we will see when the Patient Driven Payment Model (PDPM) takes effect on 10/1/19. Some of these changes include:
Clarification on assessment types available under A0310: Type of Assessment
A look at I0020B; where providers will enter the “primary reason for PPS Part A stay” diagnosis; which will be used for payment classification under PDPM
A preview of what providers will be expected to code in J2100-J5000- pertaining to major surgical procedures during prior inpatient hospital stay
Clarification of the specific questions asked pertaining to therapy delivery and minutes reported
New Assessment types/item sets of IPA and OSA
Below is a more detailed summary of the changes as well as a link to download the updated files directly from the CMS website.
A SUMMARY OF THE CHANGES A03010: Type of Assessment Shows the available assessment types effective 10/1/19
I0020B. ICD Code New item added that indicates location that providers will enter the “primary reason for the PPS Part A stay” diagnosis; which will be used for payment classification under PDPM.
J2100. Recent Surgery Requiring Active SNF Care New item added.
J2300-J5000: Surgical Procedures New items added that providers will use to indicate if and what type of major surgical procedure occurred during the prior inpatient hospital stay. This will further determine the clinical category the patient belongs in under PDPM when the diagnosis used in I0020B maps to more than one clinical category.
O0400. Therapies This will remain unchanged and still will require reporting of therapy minutes during the 7-day look back period for assessment types.
O0425. Part A Therapies New items added on PPS Part A Discharge assessments where providers will indicate the total number of therapy minutes, days and distinct calendar days therapy was provided during the most recent Part A stay.
New Assessment type “Interim Payment Assessment (IPA) Item Set”
New Assessment type “Optional State Assessment (OSA) Item Set” allows for the coding of various assessment types, as shown below:
DOWNLOAD FILES FROM CMS Updated files can be downloaded directly from the CMS website by clicking here.