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 24 hours

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: No — OT cannot independently complete the OASIS

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 24 hours 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? → No

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