Coding Instructions

for Z0100A, Medicare Part
A HIPPS Code
•
Typically, the software data entry product will calculate this value.
•
The HIPPS code is a Skilled Nursing Facility (SNF) Part A five-position billing code; the
first four positions represent the PDPM case mix version code and the fifth is the
assessment type indicator. For information on HIPPS, access:
https://www.cms.gov/medicare/payment/prospective-payment-systems/hipps-codes.
•
If the value for Z0100A is not automatically calculated
by the software data entry product, enter the HIPPS
code in the spaces provided (see Chapter 6 of this
manual, Medicare Skilled Nursing Facility Prospective
Payment System (SNF PPS), for a step-by-step
worksheet for manually determining the PDPM case
mix version code and a table that defines the assessment
indicator).
•
This HIPPS code is usually used for Medicare SNF Part
A billing by the provider.
•
Left-justify the 5-character HIPPS code. The extra two
spaces are supplied for future use, if necessary.
DEFINITION
MEDICARE-COVERED
STAY
Skilled Nursing Facility stays
billable to Medicare Part A.
Does not include stays
billable to other payers (e.g.,
Medicare Advantage plans).
DEFINITION
HIPPS CODE
Is comprised of the PDPM case
mix code, which is calculated
from the assessment data. The
first four positions of the HIPPS
code contain the PDPM
classification codes for each
PDPM component to be billed
for Medicare reimbursement,
followed by an indicator of the
type of assessment that was
completed.
Z0100: Medicare Part A Billing (cont.)
Coding Instructions for Z0100B, Version Code
•
Typically, the software data entry product will calculate this value.
•
If the value for Z0100B is not automatically calculated by the software data entry
product, enter the PDPM version code in the spaces provided.