Home Health Coding Cheatsheet
OASIS Timing Reference
| Assessment | Trigger | Window |
|---|
|-----------|---------|--------|
| SOC | First skilled visit | Within 5 days |
|---|---|---|
| ROC | Returns from hospital | Within 24 hours |
| REC | 60-day recertification | Near end of episode |
| SCIC | Significant acute change | Within episode, no hospitalization |
| Discharge | End of care | At last visit |
Medicare HH Coverage Criteria
1.Homebound (leaving requires considerable effort)
2.Skilled service need (SN, PT, OT, SLP)
3.Under physician care with certified POC (485)
4.Services reasonable and necessary
PDGM 5 Factors
| Factor | Options |
|---|
|--------|---------|
| Timing | Early (1st period) / Late (2nd+) |
|---|---|
| Admission source | Community / Institutional |
| Clinical group | 12 groups (see below) |
| Functional level | Low / Medium / High |
| Comorbidity | None / Low / High |
12 Clinical Groups (PDGM)
1.Musculoskeletal Rehab
2.Neuro/Stroke Rehab
3.Wound Care
4.Complex Medical/Surgical
5.Respiratory
6.Endocrine
7.Infectious Disease/Neoplasms/Blood
8.Cardiac/Circulatory
9.MMTA (Medication Management)
10.Behavioural Health
11.Immobility
12.GI/GU
HTN Combination Codes
| Combo | Code |
|---|
|-------|------|
| HTN + HF | I11.0 |
|---|---|
| HTN + CKD stages 1-4 | I12.9 |
| HTN + CKD 5/ESRD | I12.0 |
| HTN + HF + CKD 1-4 | I13.0 |
| HTN + HF + ESRD | I13.11 |
Wound 7th Characters
| 7th | Meaning | Example |
|---|
|----|---------|---------|
| A | Initial/active treatment | Wound VAC in place, antibiotics active |
|---|---|---|
| D | Subsequent/routine | Dressing changes, normal healing |
| S | Sequela | Late effect after healing |
Common Primary Diagnoses by PDGM Group
| Group | Common Primary Dx |
|---|
|-------|-----------------|
| Musculoskeletal | M17.11 (primary OA knee), S72.001D (hip fracture) |
|---|---|
| Wound Care | L89.xx, L97.xx, T81.31xD |
| Cardiac | I50.22, I13.0 |
| Endocrine | E11.65, E11.621 |
| Neuro/Stroke | I69.354, I69.320 |
| MMTA | I10, E11.9, J44.1 |