When it comes to the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS), the IRF-specific knowledge of your facility’s coders and PPS coordinator is vital to your success. Simply memorizing codes and applying traditional coding guidelines is not enough; health information management (HIM) coding professionals must understand nonconventional IRF guidelines and know how to use the ICD-10-CM classification system to apply these guidelines to the IRF-PAI. Coders and PPS coordinators are crucial to this process. The collaboration between the two ensures the integrity and accuracy of the codes recorded on the IRF-PAI and the UB-04, as determined by the physician documentation in the patient’s IRF medical record. Understanding IRF-PAI guidelines and ICD-10-CM coding conventions will not only help IRFs capture codes that demonstrate their compliance with the 60% rule, but also help ensure the accuracy of their IGCs, etiologic diagnoses, comorbid conditions, complications, and CMGs.

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