IRF Coding – Inpatient Rehabilitation Facility Coding

Coding By Builder

IRF Coding – Inpatient Rehabilitation Facility Coding http://www.cco.us/physician-based-medical-coding-course-info-page-yt

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Alicia: Q: Can anyone elaborate on IRF coding?

A: This was pretty interesting because I had to do some research on IRF coding. It wasn’t something I was familiar with.

So what does IRF stand for? The first thing you need to know is it’s inpatient rehabilitation facility (IRF) coding. It is, I want to say, a different ballgame, is what I’m trying to say. It can be a challenge due to Medicare Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). Now, the acronym for that is IRF PPS. This was implemented way back in 2002 to cover patients paid under Medicare Part A.

What IRF PPS requires is a completion of the IRF-Patient Assessment Instrument. Now, I’m going to be repeating this more and more, but I’m just going to use the acronym and that is called the PAI. It’s a data collection form that’s completed on admission and discharge. The conditions reported on the UB-04 (the form that’s sent in for inpatient billing) and the IRF-PAI differ, and as do the guidelines for code assignment.

These two, UB-04 and IRF-PAI kind of butt heads as we’ll show you here in just a minute. They don’t always match. So, what you put on the form to get paid for inpatient, the UB-04 and what’s put on the IRF-PAI — they aren’t going to be the same a lot of the times.
A measure was developed by the American Academy of Physical Medicine and Rehab way back in the 1980s and the American Congress of Rehab Medicine did this. It is the FIM or Functional Independence Measure. All of these abbreviations can really get you.

There is a link to these. There’s the IRF-PAI Training Manual, you have the Prospective Payment System (IRF PPS). You can look at that and that’s what you use to fill out these forms.
What is the PAI? CMS provides payment for inpatient rehab facilities through case-mix groups. Now, what they’re going to do is the information is collected on the IRF-PAI during the first three days of admission when they first get there, and include the impairment that the patient has, the FIM score, and the age of the patient. Those are all pertinent. This information is used to classify the patient into a case-mix group.