SNF PDPM ICD-10 Diagnosis and Procedural Code Crosswalk

SNF PDPM ICD-10 Diagnosis and Procedural Code Crosswalk

SNF PDPM ICD-10 Diagnosis and Procedural Code Crosswalk

The Patient-Driven Payment Model (PDPM) has brought significant changes to how Skilled Nursing Facilities (SNFs) are reimbursed for Medicare Part A stays. Understanding the ICD-10 diagnosis and procedural codes that align with PDPM is crucial for accurate reimbursement and care planning.

Overview of PDPM

PDPM, implemented in October 2019, replaced the Resource Utilization Group (RUG-IV) system for SNF Medicare Part A payments. It focuses on patient characteristics and care needs rather than therapy minutes as the primary determinant of payment.

Importance of ICD-10 Codes

ICD-10 codes play a pivotal role in PDPM by categorizing patient diagnoses and conditions. These codes help SNFs classify patients into clinical categories that influence reimbursement levels under PDPM.

Creating a Crosswalk

Developing a crosswalk between ICD-10 codes and PDPM clinical categories is essential for accurate coding and billing. This process ensures that SNFs correctly capture and report patient diagnoses to align with reimbursement criteria.

Leveraging Technology for Compliance

At Zynix , we recognize the complexity of SNF billing under PDPM and the importance of precise code mapping. Our solutions, including Medvise.AI , utilize advanced algorithms to streamline the creation and maintenance of ICD-10 and PDPM code crosswalks. This technology helps SNFs optimize reimbursement while maintaining compliance with regulatory requirements.

Benefits of Effective Code Crosswalks

A well-executed ICD-10 and PDPM code crosswalk facilitates:

  • Accurate Reimbursement: Ensures SNFs receive appropriate payment for services rendered.
  • Compliance: Helps SNFs adhere to CMS regulations and avoid penalties.
  • Efficiency: Reduces administrative burden by automating coding processes.


Creating and maintaining an accurate SNF PDPM ICD-10 diagnosis and procedural code crosswalk is essential for maximizing reimbursement and ensuring compliance. SNFs can benefit from leveraging technology-driven solutions to streamline coding processes and optimize financial outcomes under PDPM.

For more information on how Zynix can assist your SNF in navigating PDPM coding challenges, visit our website at and explore our innovative solutions at Medvise.AI .

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