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Wiki principal diiagnosis in ltac

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cmatley

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I work at a state owned long term care hospital. Patients are from nursing homes, acute care hospitals etc. Pts all have multiple chronic conditions eg vent dependent, persistent vegetative state, tbi, huntingtons, cerebral palsy... patient may be here 10-40 years- Medicare does not cover the pt until they have an acute episode of care ( uti, pneumonia ) the question is does the diagnosis of chronic respiratoy failure/vent dep become principal dx through discharge with the acute dxs second or as the biller informed me the first acute episode of care dx is principal dx and remains first listed through discharge years later. eg uti, pmn, chronic respiratory failure, vent, dm, etc.. each successive acute dx will be listed before the principal dxs. I have contacted NGS/MAC. Though they understand my logic regarding not having a uti for 10 years, the provider outreach educator stated we must follow acute inpt hospital guidelines.
If any has any insight or a contact at medicare, please contact me...
Thank you
Christiana Matley CPC
 
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