Home Health Coding and OASIS Expert

Published on Wed Aug 20, 2014 PDF

Recent Palmetto GBA medical reviews target HIPPS codes 5BHK* and 5AGK*. 

The first character in these HIPPS codes indicates that these patients received 20 or more therapy visits.

The second character in the HIPPS codes indicates the patient’s clinical severity rating. Clinical severity ratings are calculated based on a combination of coded diagnoses and responses to OASIS items M1030 — Therapies the patient receives in the home, M1200 — Vision; M1242 — Frequency of pain, M1308 — Number of unhealed pressure ulcers, M1324 — Stage of most problematic pressure ulcer, M1334 — Status of most problematic stasis ulcer, M1342 — Status of most problematic surgical wound, M1400 — Dyspnea, M1620 — Bowel incontinence frequency, M1630 — Ostomy for bowel elimination, M1810-M1860: ADLs, and M2030 — Management of injectable medications. 

The third character in the HIPPS code indicates the patient’s functional severity. Functional severity ratings are based on OASIS responses to items M1810-M1860 — ADLs.

The fourth character in these HIPPS codes is the service severity rating. Service severity ratings of 1 describe patients whose pre-admission location (in the 14 days prior to start of care) was an inpatient-acute stay.

Finally, the fifth character indicates the severity supply rating. In the case of these codes, the asterisk indicates an unspecified supply severity rating.

Source: Medicare Home Health Prospective Payment System Patient Classification Algorithm; Home Health Resource Grouper.