The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding.
Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. (difference of NE-NF and NA-NB).
The general method for calculation of any NTA category is as follows:
- Points (1-8) are assigned to specific conditions.
- Points are added together for all conditions.
- The higher the total point value, the greater the payment (CMI).
- NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+.
The Fiscal Year (FY) 2021 PDPM ICD-10-CM Mappings file includes the NTA Comorbidity to ICD-10-CM Mapping, which maps comorbidities in the NTA component captured in item I8000 to allowable ICD-10 codes.
Not all NTA’s are ICD-10 codes, some are MDS items. For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. The NTA case-mix groups are based on NTA score ranges: 0 (NF), 1 – 2 (NE), 3 – 5 (ND), 6 – 8 (NC), 9 – 11 (NB), or 12+ (NA), according to table 17, NTA Case-Mix Groups, in chapter 6 of the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.
CODING RECOMMENDATIONS
How can a facility ensure that they are not “leaving money on the table” due to under-coded NTAs?
- Know where to code what – All NTA comorbidities must be coded directly in the source identified by Table 16: NTA Comorbidity Score Calculation chapter 6 of the RAI User’s Manual. If the item is not coded at the correct item number, the facility will not receive the points. For example, Chronic Lung disease will not calculate if the ICD-10 is coded at I8000.
- Discuss NTAs as an IDT – The team may want to discuss any NTA qualifiers at the weekly utilization meeting before the 5-day PPS assessment is completed.
- Review hospital documentation – Be sure to review all of the pre-admission documentation, including the H&P, discharge summary, consultations, radiology reports, surgeon consults, etc.
- Don’t forget to review dietary documentation – Check dietary documentation for indications of morbid obesity, BMI over 40, or malnutrition or at risk for malnutrition. Query the physician if needed.
- Query Physicians and Non-physicians Providers – Often, facilities miss NTA points due to a lack of documentation. The physician should be queried for any suspected diagnoses. For example, a resident may have psoriasis on her knee and complain of pain in the same knee. The physician should be queried about Psoriatic Arthropathy.
- Most importantly, the facility must become familiar with the 50 NTA conditions and services
SUMMARY
The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. 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.