Updated: Jun 5, 2019

The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility.  

How is the NTA score determined? The NTA is determined by the presence of 50 specific conditions, comorbidities and extensive services that are coded on MDS 3.0 (with the exception of HIV/AIDS which is reported on the SNF claim).  The majority of the NTA coding takes place in section I8000, putting diagnosis coding in the spotlight.  Other conditions/services are coded in sections H, K, M and O of the MDS.  Each condition/extensive service identified on the MDS or HIV/AIDS on the SNF claim, results in a point value ranging from 1 through 8.  Once all of the conditions/extensive services are coded, all of the points are added up for a total NTA comorbidity score.  

Depending on the total NTA comorbidity score, each assessment will be assigned to one of six case mix groups and the associated case-mix index.  See below:

The case-mix index is multiplied by the federal base rate to determine the dollar amount associated with each case mix group.