Step-by-Step Coding Guide for Item Set Z0100A: Medicare Part A: HIPPS Code

1. Review of Medical Records

• Objective: Ensure accurate and comprehensive documentation of the resident's Medicare Part A stay.
• Actions:
  • Access the resident’s medical records, focusing on the period covered by Medicare Part A, including the start and end dates.
  • Verify all information related to the Prospective Payment System (PPS) assessment is complete and accurate.

2. Understanding Definitions

• HIPPS Code: The Health Insurance Prospective Payment System (HIPPS) code is a five-character alphanumeric code used to determine payment rates for Medicare Part A services.
  • Z0100A: This field is used to record the HIPPS code that applies to the resident's Medicare Part A stay.
• PDPM: Patient-Driven Payment Model, which determines the HIPPS code based on various factors like clinical characteristics, functional status, and comorbidities.

3. Coding Instructions

• Step-by-Step:
  • Step 1: Review the PPS assessment data for the resident, including all necessary components such as functional status and clinical characteristics.
  • Step 2: Utilize the CMS software or other authorized tools to calculate the HIPPS code based on the PDPM classification.
  • Step 3: Enter the calculated HIPPS code into the Z0100A field in the MDS assessment form.
  • Step 4: Ensure that the HIPPS code aligns with the PPS assessment findings and the documented care provided during the Medicare Part A stay.

4. Coding Tips

• Consistency: Ensure that the HIPPS code is consistent with the clinical documentation and PPS assessment results.
• Validation: Use software tools to validate the HIPPS code before finalizing the MDS assessment to prevent errors.
• Regular Updates: Keep informed of any updates to the PDPM system or HIPPS code classification criteria.

5. Documentation

• Objective: Maintain detailed and accurate documentation to support the HIPPS code assigned.
• Actions:
  • Document the HIPPS code calculation process, including the inputs used from the resident’s assessment.
  • Ensure that all related documentation, such as therapy records and functional assessments, are complete and reflect the care provided during the Medicare Part A stay.

6. Common Errors to Avoid

• Incorrect HIPPS Code: Entering a HIPPS code that does not align with the PPS assessment results.
• Incomplete Assessment Data: Failing to include all necessary components in the PPS assessment, leading to an inaccurate HIPPS code.
• Failure to Validate: Not using available tools to validate the HIPPS code before submission.

7. Practical Application

• Example 1: A resident with a complex clinical condition requiring extensive rehabilitation services. The PPS assessment indicates a high level of care needs, resulting in a HIPPS code that reflects a higher payment rate. After calculating the HIPPS code using CMS tools, you enter it into Z0100A and verify that it aligns with the documented care.
• Example 2: A resident with a shorter Medicare Part A stay due to a planned discharge. The PPS assessment reflects lower care needs, and the corresponding HIPPS code indicates a lower payment rate. You ensure that the HIPPS code in Z0100A matches the assessment and discharge plan.

The Step-by-Step Coding Guide for item Z0100A in MDS 3.0 Section Z is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Please note that healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, it is crucial for healthcare professionals to 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.