Home Health PDGM Calculator

calculate HIPPS code and estimated payment based on the Home Health Patient-Driven Grouping Model

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Use this calculator to find a HIPPS code and estimated payment based on the Home Health PDGM (Patient-Driven Grouping Model).

Residential Location

The location where the benificiary resides (for payment calculation)

Number of Visits

Number of visits provided for this 30-day period of care

Timing

Under the PDGM, each 30-day period is classified into one of two timing categories - early or late - depending on the timing and sequence of care.

Sequence of HH periods: Periods with no more than 60 days between the end of one period and the start of the next period.

Early: the first 30-day period in a sequence of HH periods

Late: second and later 30-day periods in a sequence of HH periods

Admission Source

Under the PDGM, each 30-day period is classified into one of two admission source categories – community or institutional – depending on what healthcare setting was utilized in the 14 days prior to home health admission.

Institutional: Acute or Post-acute care in the 14 days prior to the HH admission

Community: No acute or post-acute care in the 14 days prior to the HH admission

Note: Late 30-day periods are always classified as a community admission unless there was an acute hospitalization in the 14 days prior to the late home health 30-day period.
A post-acute stay in the 14 days prior to a late home health 30-day period would not be classified as an institutional admission unless the patient had been discharged from home health prior to the post-acute stay.

Primary diagnosis

Primary diagnosis: Enter a valid ICD-10-CM code. Used to calculate the clinical group.

Secondary diagnoses

Secondary diagnoses: Enter up to 24 valid ICD-10-CM codes. Used to calculate the comorbidity subgroup.

OASIS Items contributing to Functional Level

M1033: Risk for Hospitalization

M1033 Risk for Hospitalization: Which of the following signs or symptoms characterize this patient as at risk for hospitalization? (Mark all that apply.)

1 - History of falls (2 or more falls - or any fall with an injury - in the past 12 months)

2 - Unintentional weight loss of a total of 10 pounds or more in the past 12 months

3 - Multiple hospitalizations (2 or more) in the past 6 months

4 - Multiple emergency department visits ( 2 or more) in the past 6 months

5 - Decline in mental, emotional, or behavioral status in the past 3 months

6 - Reported or observed history of difficulty complying with any medical instructions (for example, medications, diet, exercise) in the past 3 months

7 - Currently taking 5 or more medications

8 - Currently reports exhaustion

9 - Other risk(s) not listed in 1 - 8

10 - None of the above

M1800: Grooming

M1800 Grooming: Current ability to tend safely to personal hygiene needs (i.e., washing face and hands, hair care, shaving or make up, teeth or denture care, fingernail care).

0 - Able to groom self unaided, with or without the use of assistive devices or adapted methods.

1 - Grooming utensils must be placed within reach before able to complete grooming activities.

2 - Someone must assist the patient to groom self.

3 - Patient depends entirely upon someone else for grooming needs.

M1810: Dressing Upper Body

M1810 Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps.

0 - Able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance.

1 - Able to dress upper body without assistance if clothing is laid out or handed to the patient.

2 - Someone must help the patient put on upper body clothing.

3 - Patient depends entirely upon another person to dress the upper body.

M1820: Dressing Lower Body

M1820 Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes:

0 - Able to obtain, put on, and remove clothing and shoes without assistance.

1 - Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient.

2 - Someone must help the patient put on undergarments, slacks, socks or nylons, and shoes.

3 - Patient depends entirely upon another person to dress lower body.

M1830: Bathing

M1830 Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair).

0 - Able to bathe self in shower or tub independently, including getting in and out of tub/shower.

1 - With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower.

2 - Able to bathe in shower or tub with the intermittent assistance of another person:
(a) for intermittent supervision or encouragement or reminders, OR
(b) to get in and out of the shower or tub, OR,
(c) for washing difficult to reach areas.

3 - Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision.

4 - Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode.

5 - Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath.

6 - Unable to participate effectively in bathing and is bathed totally by another person.

M1840: Toilet Transferring

M1840 Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode.

0 - Able to get to and from the toilet and transfer independently with or without a device.

1 - When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.

2 - Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).

3 - Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently.

4 - Is totally dependent in toileting.

M1850: Transferring

M1850 Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast.

0 - Able to independently transfer.

1 - Able to transfer with minimal human assistance or with use of an assistive device.

2 - Able to bear weight and pivot during the transfer process but unable to transfer self.

3 - Unable to transfer self and is unable to bear weight or pivot when transferred by another person.

4 - Bedfast, unable to transfer but is able to turn and position self in bed.

5 - Bedfast, unable to transfer and is unable to turn and position self.

M1860: Ambulation/Locomotion

M1860 Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces.

0 - Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e. needs no human assistance or assistive device).

1 - With the use of a one-handed device (e.g. cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.

2 - Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.

3 - Able to walk only with the supervision or assistance of another person at all times.

4 - Chairfast, unable to ambulate but is able to wheel self independently.

5 - Chairfast, unable to ambulate and is unable to wheel self.

6 - Bedfast, unable to ambulate or be up in a chair.


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