Home Health & Hospice Week

Get to know the new code.

Whether you know the current HH PPS HIPPS codes inside and out, or have only a vague idea what the code digits indicate, it’s vital to understand HIPPS code changes under PDGM.

Why? The five-digit HIPPS codes will set your payment level under the drastic payment reform model, Centers for Medicare & Medicaid Services officials emphasized in a Feb. 12 education call about the Patient-Driven Groupings Model.

Take a look at what the HIPPS codes mean now versus what they’ll mean come Jan. 1:

1st Digit

Then: The first digit of the HIPPS code started out in 2000 as a fixed value “H” indicating merely that the code was home health-specific, CMS notes on its website. But in 2010, when CMS switched PPS to the four equation model, the digit started indicating a combination of the episode sequence (early versus later) and therapy utilization level.

Now: Under PDGM, the first digit will indicate the timing of the episode — or “period” as CMS now calls it — and admission source.

2nd Digit

Then: Currently, the second digit indicates the clinical severity level based on a range of OASIS items — M1021/M1022/M1028 (Diagnosis codes), M1030 (Therapies), M1200 (Vision), M1242 (Pain), M1313 and M1324 (Pressure Ulcer Staging), M1334 (Stasis Ulcer Staging), M1342 (Surgical Wound Status), M1400 (Dyspnea), M1620 (Bowel Incontinence), M1630 (Ostomy), and M2030 (Injectable Medications).

Now: Under PDGM, the second digit will signal the clinical grouping based on principal diagnosis codes reported on the home health claim.

3rd Digit

Then: Currently, the third digit indicates the functional score based on six OASIS items.

Now: Under PDGM, the third digit will continue to indicate the functional impairment level, but it will be based on eight OASIS items (see box, p. 52).

4th Digit

Then: This digit will see the biggest change under PDGM, the CMS staffer indicated in the call. “Today it reports a service level,” he said, referring to the number of therapy visits.

Now: “Under PDGM, it will carry the comorbidity adjustment.” PDGM will base the adjustment on secondary diagnoses reported on the home health claim.

5th Digit

Then: When PPS began, this digit contained verification information. Now it indicates the Non- Routine Supply level, ranging from 1 to 6.

Now: Under PDGM, NRS payment will be incorporated into the base rate, and this HIPPS code digit will become a “placeholder,” the CMS official noted. As such, it will always be a ‘1.’