Home Health & Hospice

Sequence Diagnoses Based on Plan and Condition

Homecare Insider, May 4, 2009

The revised Prospective Payment System (PPS) has been in effect for almost 18 months and clinicians still have questions about case-mix diagnoses. Here is one.

When a patient has more than one diagnosis from a case-mix group, is it ideal to categorize them? For example, gastric ulcer, hepatitis or Parkinson’s disease, and Alzheimer’s disease, dementia. Do we get points for each or only once per group?

If categorizing means to list all diagnoses from one group in sequence, followed by another group in sequence, and so on, the answer would be "No." The revised PPS changes in payment in the affect the way an agency is paid; it does not change the rules for diagnosis coding and sequencing. The diagnoses must be in the order that best reflects the seriousness of the patient’s condition and impact on the homecare plan. The principal diagnosis would be the most acute condition for homecare purposes, related to the most intensive service. Following that would be the second most important diagnosis, etc. The list would also include any co-morbidities that have an impact on the patient’s responsiveness to treatment and rehabilitation prognosis. If it turned out, for instance, that gastric ulcer and hepatitis were the two most important concerns, then they would be listed first and second. However, the patient’s Home Health Resource Group (HHRG) would receive points for only one diagnosis from that group. 

The next diagnoses in this question are not all from the same group. Parkinson’s disease is from Neuro 2, peripheral neurological disorders, and Alzheimer’s disease and dementia are from Psych 2, degenerative and other organic psychiatric disorders. This patient’s HHRG would receive points from both of those groups.

The second day of the "Mastering Medicare" seminar is dedicated to diagnosis coding. There are two locations remaining in 2009: Chicago on May 18 and 19, and Nashville on June 15 and 16. For more information about the seminar — Click Here.