Home Health & Hospice Week

Diagnosis Coding:

Brainstorm Alternatives To These Top 10 RTP Codes

These codes won’t cut it any more under PDGM.

You need to be scrutinizing your current claims to see which codes will lead to returns under the Patient-Driven Groupings Model.

The list of RTP codes will vary by agency, depending on patient mix, notes Lisa Woolery with Fazzi Associates in Northampton, Massachusetts. But you can bet many of these top 10 Return to Provider codes under the new payment model, provided by Woolery and based on 2018 data, will show up on your list:

  • M62.81 Muscle weakness (generalized) (unknown etiology)
  • R26.89 Other abnormalities of gait and mobility (unknown etiology)
  • M54.5 Low back pain (unknown etiology)
  • R26.81 Unsteadiness on feet (unknown etiology)
  • M25.561 Pain in right knee (unknown etiology)
  • R33.9 Retention of urine, unspecified
  • M25.551 Pain in right hip (unknown etiology)
  • R78.81 Bacteremia
  • R29.6 Repeated falls (unknown etiology)
  • R13.10 Dysphagia, unspecified (unknown etiology)  

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