BCHHC Interview Q&A
Q: What are the five PDGM classification factors?
Q: Who can complete the OASIS and who cannot?
Can complete OASIS independently: SN (RN/LPN), PT (Physical Therapist), SLP/ST (Speech-Language Pathologist).
CANNOT complete OASIS: OT (Occupational Therapist) — OT cannot independently complete OASIS assessments.
Q: What is the difference between SOC and ROC OASIS?
SOC (Start of Care): First OASIS completed at the very start of a new home health episode. Must be completed within 5 calendar days of the first skilled visit. Opens the 60-day episode.
ROC (Resumption of Care): Completed when a patient who was on home health service is hospitalised and then returns home to resume care. Must be completed within 24 hours of the patient's return home.
Q: How do you code CVA sequela in home health?
Never code the acute stroke (I60–I63) in home health. Code the RESIDUAL DEFICITS using the I69.x sequela series. For cerebral infarction: I69.3xx. Hemiplegia left non-dominant (most common if dominance not documented): I69.354. Aphasia: I69.320. Dysphagia: I69.391. The sequela codes already imply that the stroke occurred previously.
Q: When is 7th character A used vs D for wound codes?
A (Initial encounter): Patient is receiving ACTIVE treatment — wound VAC in place, antibiotics prescribed for wound infection, wound undergoing surgical debridement.
D (Subsequent encounter): Routine care during normal healing — dressing changes only, cast checks, follow-up without active treatment.
Key: Wound VAC presence changes 7th character to A even if wound is healing.
Q: Patient has HTN + CHF + CKD stage 3 + T2DM on insulin + anemia of CKD. What is the full code sequence?
I13.0 (HTN + HF + CKD stages 1–4 combination) + I50.22 (chronic systolic CHF, if documented) + E11.22 (T2DM with diabetic CKD) + N18.3 (CKD stage 3) + D63.1 (anemia in CKD) + Z79.4 (insulin use). Never code I10 separately when I13.0 applies.
Q: What is LUPA and how does it affect an agency?
Low Utilization Payment Adjustment: when visits in a 30-day period fall below the minimum threshold for the clinical group, payment switches from the standard PDGM episode rate to a per-visit rate. LUPA payments are significantly lower. Thresholds vary by clinical group (2–6 visits). Agencies must ensure clinically appropriate visits meet LUPA thresholds and document necessity for each visit.
Q: What is the NEC vs NOS distinction?
NEC (Not Elsewhere Classified): Provider documentation IS specific, but no specific ICD-10-CM code exists for exactly that condition. The code is the best available option even though documentation is specific.
NOS (Not Otherwise Specified): Provider documentation is VAGUE or unspecified. A specific code exists but documentation doesn't support using it. Query the provider for more specificity when possible.
Q: What homebound documentation is required?
Must document a SPECIFIC limitation showing leaving home requires considerable effort: e.g., "patient is non-weight-bearing on left lower extremity and requires two-person assist to transfer," or "patient has severe dyspnea with minimal exertion, SpO2 drops to 88% with ambulation to bathroom." Brief absences (medical appointments, religious services, adult day care) do not negate homebound status. Generic statements ("patient is weak") are insufficient.
Q: How do you select the primary diagnosis for PDGM?
Primary diagnosis must: (1) directly relate to the skilled service need, (2) support homebound status, (3) be the condition the skilled service is actively treating. It is NOT necessarily the most severe diagnosis. The primary diagnosis determines the PDGM clinical group — wrong primary = wrong clinical group = wrong payment. If a wound is the reason for skilled nursing, a wound code should be primary even if diabetes is the underlying cause.
Interview Q&A
Q: What is the primary purpose of BCHHC certification?
The Board Certified Home Health Coder (BCHHC) credential validates expertise in ICD-10-CM coding specifically for the home health setting. It demonstrates competency in OASIS assessments, PDGM classification, and primary diagnosis selection — all of which directly determine Medicare reimbursement. Agencies require it to ensure accurate claim submission and compliance with CMS guidelines.
Q: How does accurate coding affect agency revenue under PDGM?
The primary ICD-10-CM diagnosis determines the PDGM clinical group (one of 12 groups). The clinical group is one of five factors that determine the 30-day payment period rate. A wrong primary diagnosis places the patient in the wrong clinical group, which can mean hundreds of dollars less per episode. Accurate coding is not optional — it is the revenue engine.
Q: What is the difference between Excludes1 and Excludes2 in ICD-10-CM?
Excludes1 means the two conditions are mutually exclusive — you CANNOT code both together. The excluded code represents a condition that cannot occur simultaneously with the condition being coded. Excludes2 means the excluded condition is NOT part of the coded condition — both CAN be coded if both are present. Example: Excludes2 on I13.0 for N18.5 (CKD stage 5) means you CAN separately code stage 5 CKD if truly present alongside the combination code condition.
Q: Under PDGM, what is the difference between community and institutional admission source?
Institutional source: patient was discharged from a hospital, skilled nursing facility (SNF), or inpatient rehabilitation facility within 14 days before the home health start of care date. Community source: all other admissions — patient came directly from home, outpatient, or was not hospitalised in the 14-day lookback window. Institutional source generally results in slightly higher reimbursement, reflecting the higher acuity of recently hospitalised patients.
Q: What is the LUPA threshold and why does it matter?
LUPA (Low Utilization Payment Adjustment) applies when visit counts in a 30-day period fall below the clinical group's minimum threshold (ranging from 2 to 6 visits depending on the group). When LUPA applies, payment switches from the standard episode rate to a per-visit rate, which is significantly lower. Coders must understand LUPA because clinical group assignment (driven by the primary diagnosis) determines the threshold. Accurate primary diagnosis selection protects against unexpected LUPA exposure.
Q: Can you code the acute CVA in home health?
No. In home health, you never code the acute stroke (I60–I63 series). By the time a patient is on home health service, they are past the acute phase. Code the residual deficits using the I69.x sequela series. The sequela codes communicate that the deficit is a late effect of a prior cerebrovascular accident.