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CMS Allowable ICD-10 Codes for the MDS Item I0020B Primary Reason for SNF Stay Field- PDPM Academy
PDPM requires an acceptable ICD-10 diagnosis code to be entered into MDS item field I0020B top represent the primary reason for the SNF stay. ICD-10 codes not on the list of allowable codes, often referred to as “return-to-provider” codes will not classify into a PDPM clinical category. CMS publishes a list ICD-10 codes that are approved for use in MDS Item field I0020B for PDPM classification purposes. The file includes the following information: 1) Alphanumeric ICD-10 code; 2) Code Description; 3) Default Clinical Category; 4) Whether a MDS Section J Surgery Code Indicating That the Resident Had a Prior Major Surgical Procedure is Needed to Refine the Default Clinical Category; 5) PT and OT Component Clinical Category; and 6) SLP Component Clinical Category. If a code is not listed in this file, it cannot be used in the MDS I0020B item field. CMS provides this file in a Microsoft Access Format. AHCA converted the CMS file into Microsoft Excel for providers that are not familiar with Microsoft Access.