BCHHC Projects and Practice Cases

Case Study 1 — CHF Management Patient

A 72-year-old female patient is admitted to home health following hospital discharge for acute-on-chronic systolic CHF. She also has Type 2 diabetes on insulin, CKD stage 3, and anemia of CKD. She is homebound due to severe shortness of breath on minimal exertion.

Code this patient:

•Primary: I13.0 (HTN + HF + CKD 1–4)

•I50.23 (acute-on-chronic systolic CHF)

•E11.22 (T2DM with diabetic CKD)

•N18.3 (CKD stage 3)

•D63.1 (anemia in CKD)

•Z79.4 (long-term insulin)

PDGM: Early + Community + Cardiac/Circulatory + (functional level from OASIS) + High comorbidity

Case Study 2 — Post-Stroke Rehabilitation

A 65-year-old right-handed male had a left middle cerebral artery infarction 6 weeks ago. He now has right-sided hemiplegia (dominant) and expressive aphasia. Admitted to home health for PT/ST/SN.

Code this patient:

•Primary: I69.351 (hemiplegia right dominant following cerebral infarction)

•I69.320 (aphasia following cerebral infarction)

PDGM: Early + Institutional + Neuro/Stroke Rehab + (functional level from OASIS)

Case Study 3 — Wound VAC Management

Patient has a post-surgical abdominal wound dehiscence with wound VAC in place. No infection. History of Type 2 DM, hypertension.

Code this patient:

•Primary: T81.31XA (disruption of external operation wound, initial — wound VAC = active treatment)

•Z48.89 (encounter for other specified surgical aftercare)

•E11.65 (T2DM with hyperglycemia — if documented)

•I10 (HTN — no cardiac/renal complication)

PDGM: Early + Institutional + Wound Care

Practice Questions

1.Which OASIS is completed when a patient returns from hospital during an active episode?

- Answer: ROC (Resumption of Care) — within 48 hours (2 calendar days)

2.Patient has a stage 3 sacral pressure ulcer. Code?

- Answer: L89.153

3.7th character for wound VAC placement on a new surgical wound?

- Answer: A — active wound treatment

4.Can an OT complete the OASIS at SOC?

- Answer: Conditionally — OT cannot independently establish eligibility (can't be the sole qualifying service at SOC), but OT can complete the SOC OASIS itself once another discipline (SN, PT, or SLP) has already established eligibility

5.What is the PDGM clinical group for L89.xx as primary diagnosis?

- Answer: Wound Care

BCHHC Practice Case Studies

Case 1: CHF + CKD + Diabetes

Patient: 74-year-old female, admitted to home health post-hospital for CHF management. Has T2DM on insulin, CKD stage 3, anemia of CKD, hypertension.

Code sequence:

•I13.0 — HTN with heart failure and CKD stages 1-4

•I50.23 — Acute-on-chronic systolic heart failure

•E11.22 — T2DM with diabetic CKD

•N18.3 — CKD stage 3

•D63.1 — Anemia in CKD

•Z79.4 — Long-term insulin use

PDGM: Early + Institutional + Cardiac/Circulatory + (functional from OASIS) + High comorbidity

Case 2: Post-Stroke Rehabilitation

Patient: 67-year-old right-handed male, 5 weeks post left MCA infarction. Right dominant hemiplegia, expressive aphasia. Admitted for PT/ST/SN.

Code sequence:

•I69.351 — Hemiplegia right dominant following cerebral infarction

•I69.320 — Aphasia following cerebral infarction

PDGM: Early + Institutional + Neuro/Stroke Rehab

Case 3: Surgical Wound with Wound VAC

Patient: Post-surgical abdominal wound dehiscence, wound VAC in place, no infection. History of T2DM and hypertension.

Code sequence:

•T81.31XA — Disruption of external operation wound, initial encounter (A = wound VAC = active treatment)

•Z48.89 — Aftercare following other specified surgical procedures

•E11.9 — T2DM (unspecified if no complications documented)

•I10 — Hypertension (no cardiac/renal complications in this scenario)

PDGM: Early + Institutional + Wound Care

Practice Questions

1.Which OASIS is completed within 48 hours (2 calendar days) of return from hospital? → ROC

2.What 7th character when wound VAC is removed, dressing changes only? → D (subsequent, routine)

3.OT evaluates for home health — can OT independently complete OASIS? → Conditional: not to establish eligibility, but yes once another discipline (SN/PT/SLP) already has, or for Discharge/Recert

4.HTN + CKD stage 5 + CHF: which combination code? → I13.11

5.CVA 3 months ago with left hemiplegia — code the acute stroke or sequela? → Sequela (I69.354)

BCHHC Certification Prep — Projects

BCHHC Projects and Practice Cases

Case Study 1 — CHF Management Patient

Case Study 2 — Post-Stroke Rehabilitation

Case Study 3 — Wound VAC Management

Practice Questions

BCHHC Practice Case Studies

Case 1: CHF + CKD + Diabetes

Case 2: Post-Stroke Rehabilitation

Case 3: Surgical Wound with Wound VAC

Practice Questions