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.
For example, a resident who has an NTA comorbidity score of 3 in an urban facility (base rate of $78.05) would have a NTA rate of $104.59. For the first three days of the stay, the rate will be $313.76 with days 4 through 100 paying $104.59.
Next Steps & Resources As we prepare for PDPM implementation, one thing a facility can start doing now is familiarizing themselves with the list of NTA conditions, comorbidities and extensive services. It is important to be aware of the conditions to look for that contribute to NTA points, as many of these have historically been omitted from diagnosis coding on the MDS 3.0. A good example of this is ensuring an applicable resident has the diagnosis code of “morbid obesity” listed in I8000 of the MDS.
Concept Rehab has developed a “NTA Simplified” tool that identifies on one page a list of the conditions/extensive services and their point value. This quick reference guide is a handy tool for the MDS Nurse and ICD-10 coding expert at your facility to familiarize themselves with and start using now, to ensure all potential diagnosis codes are captured for current residents, which will then allow for a more seamless transition to PDPM.
Additionally, a mapping tool between ICD-10 codes and NTA comorbidities can be downloaded at the CMS website by clicking here.