Good talk. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. But if discharged on 10/01/19, it must be included on the claim. No paper. Focuses on clinically relevant factors rather than volume-based services or RUG levels. It is critical that all coded conditions are accurate AND supported by nursing and physician documentation. 0000001865 00000 n PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? 2207 Morgan Ave, Suite D 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM - GEM Health Care Learn More Resource PDPM Series Part 5: Assessment Requirements. In this article, we discuss the non-therapy ancillary (NTA) component. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. (difference of NE-NF and NA-NB). NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. INTRODUCTION. 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. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P, Identification of NTA conditions and services should start even before the SNF admission. It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. If your therapist are doing Group therapy, remind them that there must be supportive documentation regarding the benefit to the resident when participating in a larger group. ! Note that for the first 3 days of the stay you get 3 times the rate shown on the map. It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a step-down facility from an acute hospital stay. This problem isnt new either but now it will drive reimbursement. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. If the resident went from the hospital directly to a LTCH first, then to your SNF, you can code the surgery because an LTCH is a post-acute long term care hospital, not an acute care hospital. Under PDPM, 50 conditions and extensive services are considered for NTA classification. ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. 0000004207 00000 n AHCA Free PDPM Archive Library of Resources for All Provider Members The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. h4Pj0^z[ 8 >BRA$+Vfa A Knowledgeable and Compassionate partner. Its interesting to note that the data CMS provided, that I am using here, came from some assessments that we no longer will be doing. I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. In it, youll find the 1,612 codes that map to the different comorbidities. program for a limited time or on a short-time basis and must meet the following requirements: hospital insurance and have eligible days left to use during the benefit period. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. The general method for calculation of any NTA category is as follows: A} 2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. It more accurately accounts for expenses and isn't overshadowed by therapy. When the variable per diem adjustment is applied, the increase NTA component goes up 3x; in the example above, the daily rate for days 1-3 would increase by $87.70 for Urban and $83.78 for Rural. ANOVA Rural versus Urban NTA case-mix (click to enlarge). Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that I am sure we'll continue to understand even more as the months go by. Also notice there are very few facilities with low NTA rates in the Appalachians. xref Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). There are a total of five rates that make up your pay under PDPM.) 1=BY)#CT 'a7bA(XdHE ? These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. This article was originally published in February 2019, and has been updated in October 2019 with several more tips. His claim's principal diagnosis is Parkinson's Disease. The following ICD-10 codes qualify: 41 Body mass index (BMI) 40.0-44.9, adult, 42 Body mass index (BMI) 45.0-49.9, adult, 44 Body mass index (BMI) 60.0-69.9, adult, 45 Body mass index (BMI) 70 or greater, adult, 01 Morbid (severe) obesity due to excess calories, 2 Morbid (severe) obesity with alveolar hypoventilation, Cross-train. Click here to visit our shop. last. Rehab and Nursing staff should complete the Section GG on the MDS form for indicated ADL tasks on Day 1-3 of admission with the admission date as Day 1. Try it out!). The Primary Diagnosis in I0020B and the Principal Diagnosis should match. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. Try Now! This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. Refer to the PDPM Calculation Worksheet for more information. endstream endobj 452 0 obj <>stream 0000009611 00000 n This update addresses two issues with the NTA comorbidities mapping. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. With this component being paid at a 3x rate for 1st 3 days of . A Knowledgeable and Compassionate partner. Highlights: Hiring both part-time 2 days/week and full-time 4-5 days/week (benefits for FT only) Hours: Monday-Friday ~7am to 4pm; no evenings, weekends, call, or holidays . The score determines NTA payment groups and indices. How to Calculate PDPM Rates: A PDPM Cheat Sheet - Experience Care: Long Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. Its important to comprehend more than just the basics of PDPM. Refer to RAI pages J37-J38 for more on coding J2100. Skilled nursing facilities now have more than a year of experience with the Patient-Driven Payment Model (PDPM), the updated case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) that includes five case-mix-adjusted payment components: physical therapy (PT), occupational therapy hWmo6+( It is important that the completion of an IPA does not reset the VPD. This is an important financial consideration that facilities will not be able to afford to miss out on because of sloppy documentation or review of the records. 0000009034 00000 n On day 4 it goes back to the rate shown. Your PDPM Questions Answered - Part 4: Non-Therapy - Relias They are assisted by certified nursing assistants (. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. Intermittent Catheterization? CMS stated in the final rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. After a qualifying hospital stay, he has returned to the SNF for aftercare of the hip fracture. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. Non-Therapy Ancillary (NTA) Services - At a Glance The Patient-Driven Payment Model (PDPM) takes effect on October 1, 2019 and represents a significantly different approach to reimbursement for care in Skilled Nursing Facilities (SNFs). 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since Any delay in getting this information is going to be problematic. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. Which codes are you most likely to actually see in the wild? border: 1px solid black; hbspt.cta._relativeUrls=true;hbspt.cta.load(2297384, '30c35813-92d3-4fa1-bc3f-6b232de017b1', {"useNewLoader":"true","region":"na1"}); Topics: The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. ordered by the patients attending physician in the facility. PDPM Goes Beyond Therapy: Finding the Hidden - Skilled Nursing News (Nursing, Social Services, Dietary and Activity Staff). to When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. PDPM - Focus on NTA - YouTube Anyone involved with ICD-10 coding should have ready access to the coding guidelines. As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. How should you prioritize your search for ICD-10 codes? Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. Patient Driven Payment Model (PDPM) - Everything You Need to Know - Relias Yes, I get that is bad. endstream endobj 438 0 obj <>/Metadata 434 0 R/OutputIntents[<>]/Pages 433 0 R/StructTreeRoot 3 0 R/Type/Catalog>> endobj 439 0 obj <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Type/Page>> endobj 440 0 obj <> endobj 441 0 obj <> endobj 442 0 obj <> endobj 443 0 obj [226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 606 0 529 0 0 0 0 0 0 0 0 0 0 659 0 0 0 0 0 495 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 503 0 0 0 0 0 0 0 813 537 538 537 0 0 0 347] endobj 444 0 obj <> endobj 445 0 obj [278 0 0 0 0 0 0 0 0 0 0 584 0 333 278 278 556 556 556 556 556 556 556 556 556 556 0 0 0 0 0 0 0 722 722 722 722 667 611 778 0 278 0 0 0 833 722 0 667 0 0 667 611 0 0 0 0 0 0 0 0 0 0 0 0 556 611 556 611 556 333 611 0 278 0 0 278 889 611 611 611 0 389 556 333 611 556 0 556 556] endobj 446 0 obj <>stream The PDPM program has six payment components. With supportive documentation, it can be coded in I5600. Report the diagnosis code that provides an 18% add-on to the nursing component when coded on the UB-04 even when not coded on the MDS. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. .com NTA Diagnosis Tool CMS identified a list of 50 conditions and extensive services associated with increases in NTA costs. In order to determine the patients NTA comorbidity score accurately, providers must identify all comorbidities for which a resident would qualify, then total the points. There must be a reason for it, right? Medical records department should already code and map for the clinical category to be able to determine principal diagnosis code and calculate expected daily rate for the facility using either the manual PDPM worksheet or software-generated calculation. You should understand those things too, reader.). Nursing and NTA Components of PDPM - Hansen Hunter & Co. P.C. The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people Ive talked to as being better than what were currently doing. Formulate a PDPM group to review the chart and come up with the residents primary or principal diagnosis and do the ICD-10 clinical category mapping. Seek advice from experts, trainers and other MDS nurses when needed to clarify any areas in the MDS assessment or PDPM calculation. When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. var divElement = document.getElementById('viz1528375166404'); var vizElement = divElement.getElementsByTagName('object')[0]; vizElement.style.width='100%';vizElement.style.height=(divElement.offsetWidth*0.75)+'px'; var scriptElement = document.createElement('script'); scriptElement.src = 'https://public.tableau.com/javascripts/api/viz_v1.js'; vizElement.parentNode.insertBefore(scriptElement, vizElement); Use the rate filter to show only the highest or lowest NTA rates. PDF FINAL PDPM Triple Check Checklist PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. What do I need to know? requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. Determinants of Payment on MDS Assessment, Section GG Rehab and Nursing Functional Score, Interdisciplinary Team Members Documentation, Nursing, Social Services, Dietary and Activity Staff), Conduct interview assessments for the Brief Interview for Mental Status (, indicating if resident has a swallowing disorder especially if on a mechanically altered diet (Puree or mechanical soft diet). PDPM Grouper Updated - Again - BriggsNetNews ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I This is especially important for those residents who are long-term and later qualify for skilled care. The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. As a result, patients with AIDS are assigned the highest point value (8 points) of any condition or service for purposes of classification under the PDPMs NTA component, and they also receive a special 18% add-on to the nursing component of the payment. tr:nth-child(even) {background-color: #f2f2f2;} PDF PATIENT DRIVEN PAYMENT MODEL - Centers for Medicare & Medicaid Services It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. 0000277284 00000 n View fullsize (10 items fit). PATIENT DRIVEN PAYMENT MODEL |4 . To assist in ensuring that you can capture all diagnoses and pertinent information to maximize facility reimbursement, I suggest doing the following (which most MDS nurses I am sure are already doing): Request for Hospital History & Physical, Progress Notes, and consults. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. hVmk#7+xG{ZMaMu{vB{[ciF3Viee2!VpIbDAy_X%_A0,R99Kb! For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. 0000002491 00000 n For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. In this post Im going to take a deeper look at it and calculate the average NTA payment by state and facility. Notice there is a big pocket of low NTA rates that covers most of Iowa. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. The NTA component, together with the nursing and non-case mix components, make up the total reimbursement for a patient day under Medicare Part A. NTA classification is based on the presence of certain comorbidities or use of certain extensive services. There is also the impact of the Variable Per Diem Adjustment Factor that is applied to the NTA Component. These conditions, along with the number of points associated with the condition and how it is reported, can be found by downloading the CMS document titled Fact Sheet: NTA Comorbidity Score. Facilities that work to establish these best practices associated with the NTA component will increase revenue and see other benefits such as improved Quality Measures, reduced readmission rates, and improve skilled documentation. Visit www.TrainingInMotion.org for more details of how we can help you achieve your PDPM goals. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c Not all NTAs are ICD-10 codes, some are MDS items. Whats in it for me? PDF PMR MDS Items PDPM - nehca.org Predicting PDPM Reimbursement - Proactive LTC Consulting As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . (Ui7A7dR;5|jDM\sEamJFK3O.C[=vBD:]'N+T_ rhc_ex>mHR&o6Bfr*W0zG3KWmxK6P46n=Jt0Pn'OGC~&S};& Dt];vwj+E0R"^T eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer, and toilet transfer assessed on the first three days of admission to the facility with the admission day counted as day 1. 2 &r}p")|@ O&]LpLk| Mvl(Pv[C0AMfxYp&NymfJXdO@QhCec*2-K8P3Tjp6'+Q :~_%`n/[w}_,0-|:%?h6'#%?7?\o(@Ln 9w9Fhe`P8B09@(@DT\QG+ (CQ {dX r4`H*B4,&0hl3()%zI[)jCN8{SNa%PED~ eT T(m:l] 43FH&"@`BN`Kk(f info@proactivemedicalreview.com, Blog by Jessica Cairns, RN, RAC-CT, CMAC, and Eleisha Wilkes, RN, RAC-CTA, Click to share on LinkedIn (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Deep Dive into Federal Regulations in a Year, Mission Possible: SNF Department Head Briefing, https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2020-Coding-Guidelines.pdf, https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_AIDS_v3_508.pdf, Special Treatments/Programs: Intravenous Medication Post-admit Code, Special Treatments/Programs: Ventilator or Respirator Post-admit Code, Special Treatments/Programs: Transfusion Post-admit Code, Major Organ Transplant Status, Except Lung, Active Diagnoses: Multiple Sclerosis Code, Active Diagnoses: Asthma COPD Chronic Lung Disease Code, Bone/Joint/Muscle Infections/Necrosis Except: Aseptic Necrosis of Bone, Active Diagnoses: Diabetes Mellitus (DM) Code, Other Foot Skin Problems: Diabetic Foot Ulcer Code, Special Treatments/Programs: Tracheostomy Care Post-admit Code, Active Diagnoses: Multi-Drug Resistant Organism (MDRO) Code, Special Treatments/Programs: Isolation Post-admit Code, Specified Hereditary Metabolic/Immune Disorders, Special Treatments/Programs: Radiation Post-admit Code, Stage 4 Unhealed Pressure Ulcer Currently present, Psoriatic Arthropathy and Systemic Sclerosis, Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Other Foot Skin Problems: Foot Infection Code, Other Open Lesion on Foot Code, Except Diabetic Foot Ulcer Code, Complications of Specified Implanted Device or Graft, Bladder and Bowel Appliances: Intermittent catheterization, Special Treatments/Programs: Suctioning Post-admit Code, Myelodysplastic Syndromes and Myelofibrosis, Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory Spondylopathies, Diabetic Retinopathy Except: Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Nutritional Approaches While a Resident: Feeding Tube, Disorders of Immunity Except: RxCC97: Immune Disorders, Pulmonary Fibrosis and Other Chronic Lung Disorders. Skilled nursing services are covered under the Federal Governments Medicare program for a limited time or on a short-time basis and must meet the following requirements: The role of the Minimum Data Set (MDS) nurses has evolved all these years from being a clinician to a financial analytical nurse because the MDS assessments have become the basis for facility reimbursement by the Medicare program. 0000002038 00000 n 0 DetI Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S Center for Medicare and Medicaid Services. The categories impact a resident's case-mix classification. (This isnt going to work well on mobile devices, FYI.). Other diagnoses will affect the Non-therapy Ancillary (NTA) component. (Click either image to enlarge.). PDPM includes a new pay category, the non-therapy ancillary or NTA. 0000002280 00000 n MDS 3.0 RAI Manual. We earn 1 NTA point for second or third degree burn coded in M1040F. (PPS) based primarily on the type and intensity of therapy services provided to the patients regardless of their acuity, unique characteristics, specific needs, or goals. Contact us now and sign up to receive our newsletters here. Educate yourself on the. Determinants of payment are based on the patients characteristics assigned to six components: Patients are assigned to classification groups known as RUG Classification Groups based on various characteristics of patients and the intensity of therapy services provided. Skilled nursing services are covered under the Federal Governments. It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a, A long-term care facility provides custodial care requiring supervised, minimal or total dependence in the performance of the activities of daily living (. ) } CMS identified a . The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. We know now that every diagnosis and condition counts. And lastly, an update on therapy revenue codes and the claim CMS Transmittal 2270 from March 13, 2019 states that beginning October 1, 2019, the Medicare contractor will no longer require therapy services to be present on SNF or Swing Bed claims. It will be imperative that the coding is accurate on the MDS for the NTA conditions. Each component has its case mix index to determine the component rate. If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. Coding Speech Related Comorbidities Under PDPM - Language Fundamentals In preparation we listened to every webinar we could find, we attended all the training we could, we visited the on-line discussion groups, we dreamed about it, had nightmares about it, we Googled it, and we read all the articles we could find hoping to comprehend all facets of PDPM. HUMk@(h; ! The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. Five Important Considerations for Successful Billing Under PDPM Speaking of individual facilities, lets take a look at that as well. (I did abbreviate a few of the names for sanity.) HU]o0}G?G< m*-$R5k'EC(K@!BE`;s 2I2,[fy@770&05 Bal[|# f1 `j[>,Uf[OrGUXore:qVKP2T(r`~F& +g80qjM8#)A{)@c}A,F^Ec{HN"!l!]_J3? CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. SNF Reimbursement - TRICARE West h2430Q0P0430S0 Prior to October 1, 2019, all SNFs which participate under the Medicare program are paid under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) based primarily on the type and intensity of therapy services provided to the patients regardless of their acuity, unique characteristics, specific needs, or goals. startxref As under the previous RUG-IV model, the presence of an AIDS diagnosis continues to be identified through the SNFs entry of ICD-10-CM code B20 on the claim. The AHCA Patient Driven Payment Model (PDPM) Resource Center provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in implementing the new Medicare Part A PDPM SNF PPS, effective October 2019. The visualization is interactive. PDF PDPM Component Variable Per-Diem and RUG-IV Rate Reference Tables Admitted in the Skilled nursing facility (SNF) within a short time (generally 30 days) of leaving the hospital and require skilled services related to hospital stay. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. you could miss something. The decision to change the definition was because CMS believes that therapists, using their clinical judgment, will allow for more flexibility and that residents often benefit from the psychosocial aspects of group therapy. PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. Of importance to note is the condition of HIV/AIDS under the NTA component. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. 0000003793 00000 n PDPM: Calculating your NTA comorbidity score - SimpleLTC Admittedly, thats a lot to look through. We earn 2 NTA points if Diabetes is coded in MDS item I2900. You can rely on us. In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. 463 0 obj <>stream . Points are added together for all conditions. PDF Comorbidities Included in NTA Comorbidity Score and Assigned Points When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category.