This session will discuss industry trends and financial impacts of PDGM primary diagnoses and PDGM comorbidity groups including identifying financial impact of each primary diagnosis group, misconceptions about capturing PDGM comorbidity groups, accurately capturing comorbidity groups, and distinguishing comorbid diagnoses that warrant physician query.

Key Takeaways

  • Comorbidities represent small number of codes (13 categories that qualify for low comorbidity adjustment)
    • Focus on high risk DX codes
    • Ensure DX codes are addressed in the POC
    • Provide education on the 13 categories/Interactions
      • Focus education on skin conditions as it is a large part of comorbidities
  • Codes with unspecified anatomical location and laterality are unacceptable
  • Many unspecified codes are acceptable (CHF, AFib,COPD)
  • Secondary DX code sequencing matters
    • Positioning can change clinical grouping in certain scenarios
    • Modifies reimbursement
  • Gather as much information as possible on the patient during referral capture


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