Step-by-Step Coding Guide for Item Set A0310H: SNF Part A PPS Discharge

This guide outlines the process for accurately coding and documenting the SNF Part A PPS discharge status in the MDS 3.0, specifically within item A0310H.

1. Review of Medical Records

• Objective: Determine if the resident’s stay under Medicare Part A has ended.
• Key Points:
  • Review the resident's medical records for documentation of the end of the Medicare Part A covered stay, including physician orders, discharge planning notes, and billing information.
  • Verify the resident's Medicare Part A coverage dates and any documentation indicating the conclusion of covered services.

2. Understanding Definitions

• Objective: Clarify the meaning of "SNF Part A PPS Discharge."
• Key Points:
  • SNF Part A PPS Discharge: Refers to the formal end of a resident’s stay that was covered under Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS). This discharge is reported when the resident either leaves the SNF or no longer meets Medicare Part A coverage criteria while remaining in the facility.

3. Coding Instructions

• Objective: Provide guidance on accurately indicating SNF Part A PPS discharge.
• Key Points:
  • Code "1" if the resident has completed their Medicare Part A covered stay and is either physically leaving the facility or staying without Medicare Part A coverage.
  • Code "0" if the resident continues to have their stay covered under Medicare Part A.

4. Coding Tips

• Ensure that the decision to code a SNF Part A PPS discharge is supported by comprehensive documentation, including evidence of the end of Medicare Part A coverage.
• Be familiar with Medicare Part A coverage criteria to accurately determine when a covered stay has concluded.

5. Documentation

• Objective: Maintain clear documentation to support the SNF Part A PPS discharge coding.
• Key Points:
  • Document the rationale for the SNF Part A PPS discharge in the resident's medical record, including the last day of Medicare Part A coverage and the reason for the coverage ending.
  • Keep detailed records of any communications with Medicare representatives or insurance carriers regarding the end of coverage.

6. Common Errors to Avoid

• Coding a SNF Part A PPS discharge without verifying the end of Medicare Part A coverage through appropriate documentation.
• Overlooking documentation that may indicate a continuation of Medicare Part A coverage, leading to incorrect coding.

7. Practical Application

• Scenario: Mrs. Linda Green has been in the facility under Medicare Part A coverage following knee replacement surgery. After completing her rehabilitation, the interdisciplinary team, including her physician, determines that she no longer meets the criteria for Medicare Part A covered services as of September 15th. Mrs. Green decides to remain in the facility as a private pay resident. The MDS Coordinator codes "1" in A0310H to indicate the SNF Part A PPS discharge and documents the coverage end date and reasons in her medical record, ensuring clear communication for billing and care planning.

The Step-by-Step Coding Guide for item A0310H in MDS 3.0 Section A is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.