Clinical Mapping Under PDPM

All ICD-10-CM diagnosis codes have been assigned to a default clinical category shown in column C in the diagnosis clinical category file. For a subset of these ICD-10-CM diagnosis codes, the category will be modified. For instance, if there were specific, related surgical procedures performed in the hospital immediately preceding admission to the skilled nursing facility, the resident could be eligible for a different ICD-10 code.

There are three surgical clinical categories where this may occur; major joint replacement or spinal surgery, orthopedic surgery (except major joint replacement and spinal surgery) and non-orthopedic surgery. The surgical procedure code lists provided will be used as a reference by the skilled nursing facility staff to augment the resident’s clinical category classification. The staff would review the information sent by the preceding hospital stay to identify any procedures defined in these surgical clinical categories.

Please refer to this process as it is further discussed in the Centers for Medicare & Medicaid Services SNF PDPM ICD-10Diagnosis and Procedural Code Crosswalk.