HIMAH | PDPM (Patient Driven Payment Model) and ICD10

Briefly summarize the course including how it relates to the business operations and/or the care of residents in the facility.


Briefly summarize the course including how it relates to the business operations and/or the care of residents in the facility.

Effective October 1st, the new PDPM payment model will rely on very specific ICD-10 codes reported on the MDS to determine the resident’s “Clinical Category” payment rate. Many codes that have been previously been reported and accepted on claims will be rejected. Now is the time to prepare by studying CMS PDPM materials, assessing the current state of coding in each building, and ensuring that facility software will provide functionality that will enable a successful transition with minimal reimbursement delays.

Participants will understand:

  • Basic concepts of what the coding process with ICD-10 involves.
  • Impact of ICD-10 on PDPM and how it drives the 10 “Clinical Categories”.
  • Specific examples of the 27,854 codes that will be rejected October 1, 2019.
  • Specific examples of the 37,214 codes that will be accepted October 1, 2019.
  • Comorbidities and how they can affect the Comorbidity Score.
  • Specific examples where acceptable mappings conflict with coding guidelines.
  • Strategies for coding success under PDPM in their own facility.


May 22, 2019


1 CEUs – Clinical Data Management


Bill Roush

Bill start in the Health Information Management (HIM) field in 1990.  Bill graduated from Western Governors University with a BS in Health Informatics and earned his RHIA.  He has worked in a number of capacities and venues with many years experience as a HIM Supervisor, HIM Director, HIM Consultant as well as Subject Matter Expert in HIM to the head of IT for the California prison system. Bill has been the President of the Sacramento Valley Health Information Association (SVHIA) for two terms and he was the SVHIA Education Chair from 2011 to 2014.  Bill has served as the Chair of the California Health Information Association (CHIA) Audio Webinar Committee as well as CHIA’s Legislation Committee. Bill earned his AHIMA-Approved ICD-10-CM Trainer designation in 2013.



The webinar will be available on-demand. This means that webinar will be recorded and sent out to all paid registrants, even if they register after the live webinar has occurred, or if they cannot make the time and date set for the live webinar.


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Access instructions for the course will be provided within 2 business days following receipt of payment. You will have 60 days to access the course after access has been granted.

Once the course is completed, you will have the ability to download the CE certificate.

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Course Includes

  • 1 Lesson
  • Course Certificate