Clinical Dimension
|
1
|
Primary or Other
Diagnosis = Blindness/Low Vision
|
3
|
3
|
3
|
3
|
2
|
Primary or Other
Diagnosis = Blood disorders
|
2
|
5
|
|
|
3
|
Primary or Other
Diagnosis = Cancer, selected benign neoplasms
|
3
|
8
|
3
|
10
|
4
|
Primary Diagnosis
= Diabetes
|
5
|
13
|
1
|
8
|
5
|
Other Diagnosis
= Diabetes
|
3
|
5
|
1
|
5
|
6
|
Primary or Other
Diagnosis = Dysphagia
AND
Primary or Other Diagnosis = Neuro 3 - Stroke
|
2
|
6
|
|
6
|
7
|
Primary or Other
Diagnosis = Dysphagia
AND
M1030 (Therapy at home) = 3 (Enteral)
|
|
6
|
|
|
8
|
Primary or Other
Diagnosis = Gastrointestinal disorders
|
2
|
6
|
1
|
5
|
9
|
Primary or Other
Diagnosis = Gastrointestinal disorders
AND
M1630 (ostomy) = 1 or 2
|
2
|
|
|
|
10
|
Primary or Other
Diagnosis = Gastrointestinal disorders
AND
Primary or Other Diagnosis = Neuro 1 - Brain
disorders and paralysis, OR Neuro 2 - Peripheral neurological disorders,
OR Neuro 3 - Stroke, OR Neuro 4 - Multiple Sclerosis
|
|
|
2
|
|
11
|
Primary or Other
Diagnosis = Heart Disease OR Hypertension
|
3
|
6
|
1
|
7
|
12
|
Primary Diagnosis
= Neuro 1 - Brain disorders and paralysis
|
3
|
8
|
5
|
8
|
13
|
Primary or Other
Diagnosis = Neuro 1 - Brain disorders and paralysis
AND
M1840 (Toileting) = 2 or more
|
3
|
10
|
3
|
10
|
14
|
Primary or Other
Diagnosis = Neuro 1 - Brain disorders and paralysis OR Neuro 2 -
Peripheral neurological disorders
AND
M1810 or M1820 (Dressing upper or lower body)
= 1, 2, or 3
|
1
|
4
|
1
|
2
|
15
|
Primary or Other
Diagnosis = Neuro 3 - Stroke
|
|
2
|
|
|
16
|
Primary or Other
Diagnosis = Neuro 3 - Stroke
AND
M1810 or M1820 (Dressing upper or lower body)
= 1, 2, or 3
|
1
|
3
|
2
|
8
|
17
|
Primary or Other
Diagnosis = Neuro 3 - Stroke
AND
M1860 (Ambulation) = 4 or more
|
1
|
5
|
|
|
18
|
Primary or Other
Diagnosis = Neuro 4 - Multiple Sclerosis AND AT LEAST ONE
OF THE FOLLOWING:
M1830
(bathing) = 2 or more
OR
M1840 (Toileting) = 2 or more
OR
M1850 (Transferring) = 2 or more
OR
M1860 (Ambulation) = 4 or more
|
3
|
3
|
12
|
18
|
19
|
Primary or Other
Diagnosis = Ortho 1 - Leg Disorders or Gait Disorders
AND
M1324 (most problematic pressure ulcer stage)
= 1, 2, 3, or 4
|
2
|
|
|
|
20
|
Primary or Other
Diagnosis = Ortho 1 - Leg OR Ortho 2 - Other orthopedic disorders
AND
M1030 (Therapy at home) = 1 (IV/Infusion)
or 2 (Parenteral)
|
5
|
5
|
|
|
21
|
Primary or Other
Diagnosis = Psych 1 - Affective and other psychoses, depression
|
4
|
6
|
2
|
6
|
22
|
Primary or Other
Diagnosis = Psych 2 - Degenerative and other organic psychiatric
disorders
|
1
|
3
|
|
3
|
23
|
Primary or Other
Diagnosis = Pulmonary disorders
|
1
|
5
|
1
|
5
|
24
|
Primary or Other
Diagnosis = Pulmonary disorders
AND
M1860 (Ambulation) = 1 or more
|
1
|
|
|
|
25
|
Primary Diagnosis
= Skin 1 -Traumatic wounds, burns, and post-operative complications
|
10
|
20
|
8
|
20
|
26
|
Other Diagnosis
= Skin 1 - Traumatic wounds, burns, post-operative complications
|
6
|
6
|
4
|
4
|
27
|
Primary or Other
Diagnosis = Skin 1 -Traumatic wounds, burns, and post-operative
complications OR Skin 2 - Ulcers and other skin conditions
AND
M1030 (Therapy at home) = 1 (IV/Infusion)
or 2 (Parenteral)
|
2
|
|
2
|
|
28
|
Primary or Other
Diagnosis = Skin 2 - Ulcers and other skin conditions
|
6
|
12
|
5
|
12
|
29
|
Primary or Other
Diagnosis = Tracheostomy
|
4
|
4
|
4
|
|
30
|
Primary or Other
Diagnosis = Urostomy/Cystostomy
|
6
|
22
|
4
|
22
|
31
|
M1030 (Therapy
at home) = 1 (IV/Infusion) or 2 (Parenteral)
|
8
|
15
|
5
|
11
|
32
|
M1030 (Therapy
at home) = 3 (Enteral)
|
4
|
11
|
|
11
|
33
|
M1200 (Vision)
= 1 or more
|
1
|
|
|
2
|
34
|
M1242 (Pain)
= 3 or 4
|
1
|
|
|
|
35
|
M1308 = Two
or more pressure ulcers at stage 3 or 4
|
3
|
3
|
5
|
5
|
36
|
M1324 (Most
problematic pressure ulcer stage) = 1 or 2
|
5
|
11
|
5
|
11
|
37
|
M1324 (Most
problematic pressure ulcer stage) = 3 or 4
|
16
|
26
|
12
|
22
|
38
|
M1334 (Stasis
ulcer status) = 2
|
7
|
7
|
7
|
7
|
39
|
M1334 (Stasis
ulcer status) = 3
|
11
|
11
|
11
|
11
|
40
|
M1342 (Surgical
wound status) = 2
|
|
2
|
3
|
|
41
|
M1342 (Surgical
wound status) = 3
|
4
|
4
|
4
|
4
|
42
|
M1400 (Dyspnea)
= 2, 3, or 4
|
2
|
2
|
|
|
43
|
M1620 (Bowel
Incontinence) = 2 to 5
|
1
|
2
|
1
|
|
44
|
M1630 (Ostomy)
= 1 or 2
|
5
|
9
|
3
|
9
|
45
|
M2030 (Injectable
Drug Use) = 0, 1, 2, or 3
|
0
|
1
|
2
|
3
|
Functional Dimension
|
46
|
M1810 or M1820
(Dressing upper or lower body) = 1, 2, or 3
|
2
|
4
|
2
|
2
|
47
|
M1830 (Bathing)
= 2 or more
|
3
|
3
|
6
|
6
|
48
|
M1840 (Toileting)
= 2 or more
|
2
|
3
|
2
|
|
49
|
M1850 (Transferring)
= 2 or more
|
|
1
|
|
|
50
|
M1860 (Ambulation)
= 1, 2, or 3
|
1
|
|
1
|
|
51
|
M1860 (Ambulation)
= 4 or more
|
3
|
3
|
4
|
5
|
Note: The data for the regression
equations come from a 20% random sample of episodes from CY 2005.
The sample excludes LUPA episodes, outlier episodes, and episodes
with SCIC or PEP adjustments.
Points
are additive; however, points may not be given for the same line
item in the table more than once.
Please see Medicare Home Health Diagnosis Coding guidance
at for https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html definitions of
primary and secondary diagnoses.
|