Home Health & Hospice Week
Check Out The Secondary Dx Groups That Will Boost PDGM Pay
CMS listened to HHGM commenters and revised the case mix category methodology. The newly proposed payment reform model will increase payment for an episode when the claim contains certain secondary diagnoses. To receive a “low” comorbidity adjustment under PDGM, an episode must have at least one code from the following 11 groups: Neuro 11 (Includes diabetic retinopathy and other blindness) To receive a “high” comorbidity adjustment under PDGM, an episode must have codes from at least one of the following 27 pairs of groups: Source: Tables 44 and 45, 2019 Home Health Prospective Payment System proposed rule.
Neuro 10 (Includes diabetic neuropathies)
Circulatory 9 (Includes acute and chronic embolisms and thrombosis)
Heart 11 (Includes heart failure)
Cerebral 4 (Includes sequelae of cerebrovascular diseases)
Neuro 5 (Includes Parkinson’s Disease)
Skin 1 (Includes cutaneous abscess, cellulitis, and lymphangitis)
Neuro 7 (Includes hemiplegia, paraplegia, and quadriplegia)
Circulatory 10 (Includes varicose veins with ulceration)
Skin 3 (Includes diseases of arteries, arterioles and capillaries with ulceration and nonpressure chronic ulcers)
Skin 4 (Includes stages Two-Four and unstageable pressure ulcers by site).
Home Health & Hospice Week
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