HCAF 2020 Home Care Warm Up

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Is Coding Under the PDGM Rocket Science? Let's Bring You Back Down to Earth!

Tuesday, January 14

10:15-11:45 AM

Presented by Sharon Litwin, 5 Star Consultants​

So, the Patient-Driven Groupings Model (PDGM) is effective as of January 1, 2020, and there's no doubt that coding has significantly changed under the new payment methodology. During this session, we will review issues that can arise with ICD-10-CM coding under the PDGM, primarily through case study analyses. We will then discuss action plans that home health agencies can implement in order to be viable under the PDGM. The transition may be bumpy so far, but we will look at where you need to go.

Two of the five PDGM subgroups are directly coding-related: Clinical Grouping and Comorbidity. What happens when the only diagnosis you have from the physician is an unaccepted diagnosis? Do you use another diagnosis from the referral source/physician? What if the clinical record doesn’t align with the primary diagnosis? What alternatives are there?! What about comorbidities — how do you ensure that YOU get the high comorbidity adjustment? (Tip: you can’t! It depends on the patient and following the coding guidelines and physician documentation!). But, how do you know where to put the diagnosis, and what interaction conflicts exist?

These and other head scratching scenarios will be reviewed in this session. Let's not let coding under the PDGM be rocket science!