J2000: Prior Surgery – CMS Updates Coding Instructions

After the RAI manual updates were released for October 2018, an errata document was posted to the Centers for Medicare & Medicaid Services website concerning J2000: Prior Surgery. In the Coding Tips on page J-35, there were three criteria for a procedure to be classified as major surgery and now there are only two criteria:   

  • the resident was an inpatient in an acute care hospital for at least one day in the 100 days prior to admission to the skilled nursing facility, and
  • the surgery carried some degree of risk to the resident’s life or the potential for severe disability.

CMS deleted the requirement for the surgery to have been performed under general anesthesia. If in doubt about whether to code regional or other anesthesia here, the MDS coder may consult the elder’s physician. Some types of anesthesia may carry slightly greater risk among the elderly, and some other types of anesthesia carry risk of death or severe disability. This item was added to the Prospective Payment System (PPS) five-day MDS only for Original Medicare A residents in a Skilled Nursing Facility stay. It is used to determine certain risk adjustments for some of the new SNF-Quality Reporting Program quality measures.

Two coding examples for this item were also updated on page J-37. Changes are in italics below:

Example 1:

Mr. A’s wife informs his nurse that six months ago he was admitted to the hospital for five days following a bowel resection (partial colectomy) for diverticulitis. Mr. A’s wife reports Mr. A has had no other surgeries since the time of his bowel resection. Coding: J2000 would be coded 0, No.

Rationale: Bowel resection is a major surgery that has some degree of risk for death or severe disabilityand Mr. A required a five-day hospitalization. However, the bowel resection did not occur in the last 100 days; it happened six months ago, and Mr. A has not undergone any surgery since that time.

Example 2:

Mrs. G was admitted to the facility for wound care related to dehiscence of a surgical wound subsequent to a complicated cholecystectomy. The attending physician also noted diagnoses of anxiety, diabetes and morbid obesity in her medical record. She was transferred to the facility immediately following a four-day acute care hospital stay. Coding: J2000 would be coded 1, Yes.

RationaleIn the last 100 daysMrs. G underwent a complicated cholecystectomy, which required a four-day hospitalization. She additionally had comorbid diagnoses of diabetes, morbid obesity, and anxiety contributing some additional degree of risk for death or severe disability.

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