Coding, Classification and Reimbursement

Clinical Categories in SNF PPS PDPM - Spinal Surgery

  • 1.  Clinical Categories in SNF PPS PDPM - Spinal Surgery

    Posted 8 days ago
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    I received a question from a graduate of my HIM program concerning Z codes for Spinal Surgery aftercare at a SNF.

    She was coding aftercare for laminectomies as Z47.89, but the newly released PDPM Clinical Category Mapping lists the default clinical category for that code as Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery).

    If she codes it as Z47.1, aftercare following joint replacement surgery, she must additionally code the joint, and Z96.6x does not include any vertebra. The default clinical category for Z47.1 is Major Joint Replacement or Spinal Surgery.

    What is the appropriate code to use in the case of aftercare for spinal surgical procedures that will map to the correct Clinical Category?

    All responses will be greatly appreciated.  

    Rachel Cloward
    HIM Program Director and Assistant Professor of Health Sciences


  • 2.  RE: Clinical Categories in SNF PPS PDPM - Spinal Surgery

    Posted 7 days ago
    Hi Rachel!  Have you checked out the new AHIMA Engage Long Term Post Acute Care community?  Lots of PDPM info and resourceful contacts there!

    Regarding your question, I believe CMS recently said that the Clinical Categories will change based on Major Surgical boxes that are checked in Section J of MDS.

     CMS recently posted some great PDPM videos:

    Patient Driven Payment Model: What is Changing (and What Is Not)


    Integrated Coding & PDPM Case Study



    Section GG: Functional Abilities and Goals


    Bill Roush, RHIA, BSHI, AHIMA-Approved ICD-10-CM Trainer