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PDGM ICD Lookup. In the new PDGM (Patient Driven Groupings Model) payment model effective 2020, the Primary Dx will be very important in order to determine what payment group your claim will fall under. There are over 43,000+ primary Dx codes. Your primary diagnosis code MUST be on this list.
CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective January 1, 2020. The PDGM relies more heavily on clinical characteristics, and other patient information to place home health periods of care into meaningful payment categories.
ICD-10-CM Search - Fast, Free, and Current. Designed for healthcare professionals and patients, our tool provides quick access to the current list of American ICD-10-CM diagnosis codes. Search features include: Detailed Code Exploration: Search by code name, descriptions, and clinical terms.
A handy calculator to guide you step-by-step through gathering the data necessary to determine a HIPPS code and estimated payment based on the Home Health PDGM (Patient-Driven Grouping Model).
Change Request 11081 implements the policies of the Patient-Driven Groupings Model (PDGM), effective with claim “From” dates on or after January 1, 2020. For more information, please refer to the following resources.
Effective for claims with a “From” date on or after January 1, 2020, Change Request (CR) 11081 implements the policies of the home health Patient-Driven Groupings Model (PDGM) as described in the Calendar Year (CY) 2020 home health (HH) final rule (CMS-1711-FC).
Review the list of ICD–10–CM codes and their assigned clinical groupings. Don’t forget that symptom codes and unspecific codes are not acceptable as primary codes. Be sure to follow ICD-10 guidelines for sequencing. Put diagnoses in the order that best reflects the patient’s condition and necessity of services.
PDGM is an attempt by CMS to give agencies the reimbursement necessary based on the estimated cost of care for the patient according to the diagnosis coding and OASIS assessment. PDGM uses ICD-10 diagnosis coding to develop 6 clinical groupings and 6 more sub groupings.
The PDGM is a new payment model for the Home Health Prospective Payment System (HH PPS) that relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds.
To find a diagnosis code that is acceptable under PDGM, select a clinical grouping category above the code search before searching for the ICD code. This will filter only PDGM codes for you to choose from.