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Understanding Diagnosis Coding in PDGM for Compliance …

Understanding Diagnosis Coding in PDGM for Compliance and Optimum Financial Performance 9/25/2019. Understanding Diagnosis Coding in PDGM for Compliance and Optimum Financial Performance The art of life is a constant readjustment to our surroundings. - - Kakuzo Okakaura 2. 1. 9/25/2019. TABLE OF CONTENTS. Explain the Impact of Coding under PGDM. Evaluate the specificity requirements of Coding under PDGM. What your agency should be doing now to prepare for Coding under PDGM. 2019 5 Star Consultants, LLC. 3. PDGM Payment Groupings Overview\. CY 2019 Home Health final rule, PDGM will be implemented for 30-day periods of care starting on or after January 1, 2020. PDGM uses 30-day periods as a basis for payment. 30-day periods are categorized into 432 case-mix groups for the purposes of adjusting payment in PDGM.

• From Principal Diagnosis Reported on Claim – Comorbidity Adjustment • From Secondary Diagnoses Reported on Claim • Clinical Group Coding – Key component of determining payment in PDGM is the 30-day period’s clinical group assignment • Based on the principal diagnosis code for the patient as reported by the HHA on the home health ...

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