Last week, the Centers for Medicare and Medicaid Services (CMS) issued a
correction to the
FY 2024 SNF PPS final rule (previously referred to as “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2024”), which was effective October 1, 2023. There were technical errors that CMS identified and corrected in the new document. These corrections are applicable as if they had been included in the FY 2024 SNF PPS Final Rule.
In the final rule, CMS stated it would add the surgical option that allows a subset of subcategory S42.2—codes for displaced fractures to be eligible for one of two orthopedic surgery categories. Additionally, CMS stated that it would add this surgical option to the subcategory of M84.5—codes for pathological fractures to certain weight bearing bones to be eligible for one of two orthopedic surgery categories.
In the final rule, CMS inadvertently stated that this proposal applied to 45 of the codes within the subcategory S42.2 codes and to 46 of the codes within the subcategory M84.5 codes. However, these numbers were inadvertently swapped, meaning that the proposal applied to 46 of the codes within the subcategory S42.2 codes and to 45 of the codes within the subcategory M84.5 codes. The notice issued last week on April 10 corrected this error.
The following table includes the codes affected by the correction notice:
In addition, CMS is correcting errors in the clinical category assignment of two codes, B99.8 (Other infectious disease) and B99.9 (Unspecified infectious disease) to reinstate its prior year’s assignments from the FY 2023 SNF PPS final rule, which will be corrected to be ‘‘Medical Management’’.
CMS will post the updated mapping in the PDPM Resources section at the bottom of the Patient Driven Payment Model site. Providers should check with their software vendor to verify if the updated mapping has been applied and if any corrections are needed to prior billing (i.e., any changes in HIPPS codes).