Overview
ICD-10-CM coding accuracy is required for billing under the Patient-Driven Payment Model (PDPM), MDS coding and accurate billing. Accurate ICD-10-CM coding is also required to correctly enter diagnoses in resident records at the highest degree of specificity documented by the resident’s physician/extender. One of the important functions of the MDS assessment is to generate an updated, accurate picture of the resident’s current health status, which includes correct ICD-10-CM coding. Nurses do not learn ICD-10-CM coding during formal nursing training but are required to identify active diagnoses for the residents. This webinar will provide basics of ICD-10-CM and identify how diagnosis codes impact PDPM, billing, Quality Measures and MDS accuracy.
Learning Objectives:
1. State the correct process for determining the ICD-10 code from the physician’s documented diagnoses.
2. Identify which practitioners can diagnose.
3. Explain the process for identifying the main term for diagnoses to assist clinicians to locate the basic code in the Alphabetic Index.
4. Describe the difference between Excludes 1 and Excludes 2 notes.
Instructor
Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC
Carol Maher is a Board Certified Gerontological Registered Nurse with over 30 years of long term care experience and has worked in long term care in many roles. She worked as the MDS Coordinator in a 300 bed SNF in Pennsylvania for 8 years before moving to CA to become the MDS Coordinator/Director for a 1200 bed SNF in San Francisco. She has also worked as the MDS Coordinator in a SNF that typically had 60-75 residents on Medicare in addition to 160 long-term care residents. Most recently she was the Senior VP of Utilization Services and Director of Reimbursement for large multi-facility organizations.
Carol has worked as one of the Gold Standard nurses for MDS 3.0, serving on the RAP workgroup to prepare the way for the CAAs for MDS 3.0, and participating on a number of Technical Expert Panels related to MDS, Quality Measures and care planning. A sought-after speaker, she has given presentations at AANAC, AHCA and Leading Age national conferences as well as many state organization presentations. She is also a frequent author of articles related to the RAI process and PPS. Carol served as a member of the AANAC Board of Directors for 9 years. She is presently serving as the chair of the AANAC Expert Advisory Panel and as an AANAC Master Teacher of the RAC-CT and RAC-CTA certification courses. Ms. Maher is the Director of Education for Hansen Hunter, providing MDS and Medicare classes across the country, presenting monthly educational webinars and completing compliance audits. She is the author of Long-Term Care MDS Coordinator’s Field Guide (HCPRO 2016).
Credit Hours
- 1.5 hours for Licensed Nurses
- 1.5 NAB hours for Nursing Home Adminstrators
This pre-recorded webinar expires on April 26, 2026.