Principal diagnosis at the LTAC is infection of the graft site. 0000060147 00000 n LTAC fixed per diem rate - A daily amount used to determine payment for specific services provided in long-term acute care (LTAC) hospitals. If the majority of them meet acute care criteria for assignment of a principal diagnosis, which one is chosen? Second, patients admitted to an LTAC must average at least a 25-day length of stay. %%EOF A patient may be admitted to the LTAC on the third day following a stroke or an acute fracture. A long-term acute care hospital (LTACH), also known as a Long Term Care Hospital (LTCH), is a hospital specializing in treating patients requiring extended hospitalization.Hospitals specializing in long-term care have existed for decades in the form of sanatoriums for patients with tuberculosis and other chronic diseases. x�b```f``���$�22 � P��90 She was brought to the acute care hospital in a dehydrated state with an elevated temperature. What is a Long-Term Acute Care Hospital (LTAC)?“Long-term acute care hospital” is defined as a hospital with an average length of stay that is longer than 25 days, yet it is neither a rehabilitation nor a psychiatric hospital (according to Medicare definitions.) �3����,>��+��m ������H��S�ܜ�c���i�S2u���mQ8�R��Q�h6*�BC�f���UO��` � =� March 17, 2016. The same, one-time deductible applies for each benefit period, whether that care happens in a hospital, SNF, or a long-term care hospital. I n the postacute continuum space, long-term acute care hospitals (LTCH) have been commonly misunderstood, as the term “long-term” historically has applied to long-term nursing facilities. Emails full of tips, news, resources and advice will be sent your way soon. High Cost Outlier. First, they are reimbursed on a cost-based basis. Understanding the similarities and differences of coding in this setting is a challenge unlike any that you find when coding in the acute care hospital. ��w�G� xR^���[�oƜch�g�`>b���$���*~� �:����E���b��~���,m,�-��ݖ,�Y��¬�*�6X�[ݱF�=�3�뭷Y��~dó ���t���i�z�f�6�~`{�v���.�Ng����#{�}�}��������j������c1X6���fm���;'_9 �r�:�8�q�:��˜�O:ϸ8������u��Jq���nv=���M����m����R 4 � Principal diagnosis at both facilities is the AMI. NHSN is the HAI surveillance gold standard. 5/18/2016 8 . �ꇆ��n���Q�t�}MA�0�al������S�x ��k�&�^���>�0|>_�'��,�G! The principal diagnosis at the LTAC may, on occasion, be the same as in the STAC. In order for a facility to qualify as an LTCH under Medicare, the average length of stay of a patient must be greater than 25 days, unless the facility qualifies under section 1886(d) of the Social Security Act. 163 16 The courses were so relevant and very clearly written! D. The patient is admitted to the STAC with CAD, undergoes a CABG surgery and presents at the LTAC with complications, including pneumonia, graft site infection and sternal wound dehiscence. An HCO is an adjustment to the applicable LTCH PPS payment rate (either the site neutral rate or the standard Federal rate) for LTCH stays that exceed the typical cost for cases with a similar case-mix. The LTAC is equipped to treat these patients for a number of reasons. H���yTSw�oɞ����c [���5la�QIBH�ADED���2�mtFOE�.�c��}���0��8�׎�8G�Ng�����9�w���߽��� �'����0 �֠�J��b� The patient is admitted with congestive heart failure and renal failure. 0000002118 00000 n Highly recommend this course. ; D ays 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime). %PDF-1.4 %���� 0000004003 00000 n ŠCode 518.81, Acute respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. Hence, LTAC hospitals were created. Dec 16, 2016 … All requirements of the Medicaid program expressed in law, regulation, and policy statement, …. trailer 0000007037 00000 n Patient is admitted to the STAC for infected stage III decubitus ulcer with MRSA. centers for medicare & medicaid services – TN.gov. In order to participate with BCBSM as a Long-Term Acute Care Hospital in the Traditional or MA PPO Programs the facility must, at minimum, have and maintain the following: licensure by the state of Michigan as an acute care hospital Medicare certification as a Long-Term Acute Care Hospital (i.e., facilities do not qualify She went into respiratory failure at the STAC and was ventilated. 0000002418 00000 n Long-term Acute Care (LTAC) - Inpatient intensive long-term care services provided in agency -approved LTAC hospitals to eligible medical assistance clients who require Level 1 or Level 2 services. The patient transfers to the LTAC on the ventilator. Use and interpretation of the ICD-9-CM coding guidelines pose specific difficulties not routinely found in the short-term acute care hospital setting. Principal diagnosis on the above cases is Admission for Rehabilitation (Reference: Coding Clinic for ICD-9-CM, Volume 14, Number 3, Third Quarter 1997, pp. Tracking Infections in Long-term Acute Care Facilities. The complexly ill patient, requiring an extended stay, would fall into the category of an outlier—a financial disaster for the short-term hospital. Acute Care Coding. The federal government realized the need for a different type of hospital, one that is DRG exempt and would specialize in those patients requiring a comprehensive treatment approach for all their diagnoses and complications. long-term acute care (LTAC) facilities, see the Inpatient Hospital Services module. 0000001162 00000 n So, go back to the initial case scenario, and based on the information provided within this article, you should be able to come up with the principal diagnosis for this case. An experienced coder in the LTAC setting comes to rely heavily on both coding guidelines and common sense. y�*�� ��[��Tٍꑄ �Xw���(�R��� #*G��ì�JJr�8h-�� �% Principal diagnosis at the STAC is diabetic foot ulcer. Medicare certifies LTCHs as acute care hospitals as part of its condition of participation in the Medicare program. Long-term acute care (LTAC) hospitals are facilities that specialize in the treatment of patients with serious medical conditions that require acute care on an ongoing basis. Nice to study and work at one's own pace online. Some of the state required codes vary by provider type and services being billed. Since the mid 1980s, Medicare has reimbursed hospitals using the DRG system. Principal diagnosis at the LTAC is osteomyletis. N'��)�].�u�J�r� When do you use the diagnosis from the acute care setting and extend it to the LTAC? LTCHs are excluded from the Inpatient Prospective Payment System (IPPS) and must meet state licensure for their location. For an example and comparison of how the LTAC differs from other methods of treatment, see the accompanying table. When can one say that the condition is no longer acute and the late effect codes must be used: three days? What is her principal diagnosis? Long-Term Acute Care Program Billing Guide October 1, 2016 Every effort has been made to ensure this guide’s accuracy. They arose from the need for treatment of patients who are expected to need an extended hospital stay. endstream endobj 171 0 obj<> endobj 172 0 obj[/ICCBased 175 0 R] endobj 173 0 obj<> endobj 174 0 obj<> endobj 175 0 obj<>stream Patient is admitted to the STAC with diabetic foot ulcer and gangrene, undergoes a transmetatarsal amputation of the toes, develops osteomyletis at the amputation site and is transferred to the LTAC. HOSPITAL CARE • Length of stay averages 25 days • Patients are acutely ill/medically complex • Care is more acute and focused than in a SNF or IPR setting • Licensed as an Acute Care Hospital Principal diagnosis at the LTAC is respiratory failure; principal procedure is the ventilation. 0000001379 00000 n Although these patients present with difficult case histories, the following may be helpful in determining the principal diagnosis (the assumption is made that all diagnoses meet acute care criteria and patients are treated for all conditions): The main coding principals used in the above case samples are: “PDX #4—Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis” and “PDX #5—Two or more diagnoses that equally meet the definition for principal diagnosis” (Reference: Coding Clinic for ICD-9-CM, Volume 7, Number 2, Second Quarter 1990, p. 4). * D ays 61-90: $352 coinsurance each day. To group diagnoses into the proper DRG, CMS needs to capture a Present on Admission (POA) Indicator for all claims involving inpatient admissions to general acute care hospitals. The system (and its predecessors) started years ago helping a few hundred healthcare facilities; today, more than 17,000 healthcare facilities use NHSN as the cornerstone of their HAI elimination strategies. Third, the LTAC specializes in treatment of the catastrophic patient, and focuses its time and talents solely on those patients who otherwise would be lost in the DRG world of reimbursement. applicable Inpatient Rehabilitation and Long-Term Acute Care (LTAC) Facility Payment Policy. Her course continued downhill, and she developed atrial fibrillation, a urinary tract infection and deep vein thrombosis. 0000004367 00000 n Patient is admitted to the STAC with an acute myocardial Infarction (AMI), CAD, and transferred to the LTAC. 2 About this guide* 0000003738 00000 n *UV�-����!��5y�1)����W�O���b�'%�?Q ���À]�]@� ���] ��.��}"`���z�i؀�Nt``���]���h � R4�e��$�FG���@�H�a�"�a1�Rd{�F3C(�(�db4� ��f��y�Xv*�t����$ư�A��:'P� ���� ��W[�30D0��\�0�����QHruA�,�� � �/b����d%�7 H B. HMI Provides Acute Care Coding, Case Management Services and Revenue Cycle Management Services for Facilities. 0000001548 00000 n Try again later. She was evaluated and subsequently transferred to the long-term acute care (LTAC) hospital with the above diagnoses and on the following IV medications: Lasix, Coumadin and Zosyn. Happy coding! Pneumonia is the principal diagnosis at the STAC; myelodsyplastic syndrome is the principal diagnosis at the LTAC. By statute, there are no LTCH units; however, there are satellite and hospital-within-hospital LTCHs that are co-located with acute-care hospitals and other Medicare providers. ; Each day after the lifetime reserve days: all costs. A. I have 3 small kids. ��(�H�`�Q�P�� �r�Q����\`Z-|� Principal diagnosis at the STAC is CAD. A claim can be made for the fact that a stroke is still evolving or the fracture takes weeks to months to heal. �V��)g�B�0�i�W��8#�8wթ��8_�٥ʨQ����Q�j@�&�A)/��g�>'K�� �t�;\�� ӥ$պF�ZUn����(4T�%)뫔�0C&�����Z��i���8��bx��E���B�;�����P���ӓ̹�A�om?�W= During the postoperative hours, the patient suffered a cerebrovascular accident. Long-Term Care Hospital Prospective Payment ystem MLN Booklet Page 6 of 13 ICN MLN006956 March 2020. Titled Long Term Acute Care Coding, the online, on-demand course is designed to provide the foundational training needed for coders in the LTAC / LTACH setting. 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