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Home Health & Hospice Week

Diagnosis Coding:

Grouper Calculation To Change Based On This Coding Shift

Published on Thu Aug 23, 2012

PPS methodology leaves agencies with questions.The Centers for Medicare & Medicaid Services' 2013 PPS proposed rule spells out changes to the grouper that could have a big impact on the case mix points your agency earns. Find out what the changes to M1024 -- Payment Diagnoses could mean to your bottom line.Old way: Currently, home health coders can use M1024 when the principal diagnosis listed in M1020a is a V code and the V code displaces a current case mix diagnosis that is contained within one of three designated home health PPS diagnosis groups. The three designated home health PPS diagnosis groups are Diabetes; Skin 1 -- Traumatic wounds, burns, and post-operative complications; and Neuro 1 -- Brain disorders and paralysis.New way: In the proposed rule, CMS announces plans to make an adjustment to the grouper so that diagnosis codes in these categories earn the same points whether listed in M1020a or immediately [...]
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