BCHHC — Home Health Coding Certification

What is BCHHC?

The BCHHC / BCHH-C (Board Certified Home Health Coder) is a professional certification for home health medical coders. It validates expertise in ICD-10-CM coding for home health, OASIS assessments, and the PDGM payment model.

Needs verification: which organization currently administers this credential and under what name. Sources associate it variously with the Board of Medical Specialty Coding & Compliance (BMSCC), the Association of Home Care Coding & Compliance (AHCC), and WellSky's credentialing program — this space has seen naming/administration changes. Confirm the current certifying body, exam format, and registration process directly before treating any of the details below as current.

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BCHHC Exam Overview

Detail	Info

|--------|------|

Certifying Body	Verify current administering organization (see note above) before relying on this
Exam Format	Multiple choice, case-based scenarios (verify current format)
Prerequisites	Experience in home health coding recommended
Renewal	Every 2 years with continuing education (verify current requirement)
Focus Areas	ICD-10-CM, OASIS, PDGM, coding guidelines

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Core Knowledge Areas

1. ICD-10-CM for Home Health

•Code structure and conventions (NEC, NOS, Excludes1, Excludes2)

•Principal/primary diagnosis selection

•Sequencing rules for home health setting

•Combination codes (HTN+HF+CKD, DM+CKD)

•Wound coding: pressure (L89), non-pressure (L97), post-surgical (T81)

•7th character selection: A (active treatment), D (subsequent), S (sequela)

2. OASIS Assessments

Type	Trigger	Timing

|------|---------|--------|

SOC	First skilled visit	Within 5 days
ROC	Returns from hospital	Within 48 hours (2 calendar days)
REC	Recertification	Near end of 60-day episode
SCIC	Acute change in condition	Within episode
DC	Discharge	At last visit

Who fills OASIS: SN (RN/LPN), PT, SLP can complete OASIS at any timepoint independently. OT cannot independently establish eligibility (can't be the sole qualifying service at SOC), but can complete SOC OASIS once another discipline already has, and can independently complete Discharge/Recertification OASIS (effective Jan 1, 2022 CMS rule change).

3. PDGM — Patient-Driven Groupings Model

Five classification factors per 30-day payment period:

1.Timing — Early (1st period) vs Late (subsequent)

2.Admission source — Community vs Institutional (post-hospital)

3.Clinical grouping — 12 groups based on primary ICD-10-CM code

4.Functional level — Low/Medium/High from OASIS functional items

5.Comorbidity adjustment — None/Low/High from secondary diagnoses

12 PDGM Clinical Groups (corrected to match official CMS naming — verify against current CMS PDGM documentation):

Musculoskeletal Rehabilitation · Neuro/Stroke Rehabilitation · Wounds · MMTA–Surgical Aftercare · MMTA–Cardiac and Circulatory · MMTA–Endocrine · MMTA–GI/GU · MMTA–Infectious Disease, Neoplasms, Blood-Forming Diseases · MMTA–Respiratory · MMTA–Other · Behavioral Health · Complex Nursing Interventions

4. Homebound Documentation

•Leaving home requires considerable effort due to illness/injury

•Brief absences allowed: medical appointments, religious services, adult day care

•Must document specific limitation, distance/effort to leave, assistance needed

•Examples: SOB on exertion, non-weight-bearing, severe cognitive impairment

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High-Yield Coding Scenarios

HTN + CHF + CKD Stage 3

I13.0   HTN with HF and CKD stages 1–4
I50.22  Chronic systolic heart failure
N18.3   CKD stage 3
Z79.4   Long-term insulin use (if applicable)

Never code I10 separately when I13.0 applies.

CVA Sequela in Home Health

I69.354  Hemiplegia left non-dominant (default if dominance not documented)
I69.320  Aphasia following cerebral infarction

Never code the acute stroke (I63-) — sequela codes imply post-infarction.

Wound Dehiscence with Wound VAC

T81.31XA  Disruption of external operation wound — 7th char A (active treatment)
Z48.89    Aftercare following surgery

Wound VAC present = active treatment = A. No wound VAC = D.

Diabetes Full Scenario

Patient: T2DM + CKD stage 3 + anemia of CKD + insulin

E11.22  T2DM with diabetic CKD
N18.3   CKD stage 3
D63.1   Anemia in CKD
Z79.4   Long-term insulin use

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Exam Preparation Strategy

6-Week Study Plan

Week	Focus

|------|-------|

1–2	ICD-10-CM conventions, NEC/NOS, Excludes1/2, combination codes
3	OASIS types, timing, who fills, clinical documentation
4	PDGM — 5 factors, 12 clinical groups, LUPA thresholds
5	High-frequency coding scenarios: wounds, CVA, diabetes, HTN combos
6	Mock exams + timed practice cases

Key Resources

•AAPC Home Health coding curriculum

•CMS ICD-10-CM Official Guidelines (free on CMS.gov)

•CMS PDGM Final Rule and fact sheets

•OASIS Data Specifications (current version)

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Practice Questions

Q: A patient had a stroke 4 months ago. She now has right hemiplegia (non-dominant). What code?

I69.351 — Hemiplegia and hemiparesis following cerebral infarction, right non-dominant side.

Q: Wound VAC is removed. Dressing changes only. Which 7th character?

D — Subsequent encounter. No active wound VAC = routine healing.

Q: OT evaluates a patient for home health. Can OT complete the OASIS?

Conditionally. SN, PT, and SLP can complete OASIS at any timepoint independently. OT cannot independently establish eligibility — OT alone can't be the sole qualifying service at Start of Care — but OT can complete the SOC OASIS once another discipline (SN, PT, or SLP) already has, and can independently complete Discharge and Recertification OASIS on its own.

Q: Patient has HTN + ESRD + CHF. Which combination code?

I13.11 — Hypertensive heart and chronic kidney disease, heart failure, ESRD.

Q: Primary diagnosis places patient in Wound Care clinical group. What is needed?

A wound-related primary ICD-10-CM code — such as L89.x (pressure ulcer), L97.x (non-pressure ulcer), or T81.31xD (surgical wound dehiscence).

Home Health Coding — Certification