In the 2023 Home Health Final Rule (click here to watch the HPS Alliance Home Health Final Rule webinar presented by Melinda A. Gaboury), there are changes related to the PDGM model that will go into effect January 1, 2023. There are numerous changes to the ICD-10 coding that went into effect on October 1, 2022. All coding changes that occurred this year were covered in a free HPS (Healthcare Provider Solutions) webinar with Melinda A. Gaboury, CEO and Director of OASIS & Coding Reviews, Robbi James.

Removal of Diagnosis Codes Under PDGM Model

There are over 42,000 diagnosis codes acceptable as a primary diagnosis under the PDGM model. That list has been adjusted, removing 155 codes from that list effective January 2023. If you have been using any of these 155 codes as primary diagnosis in your organization, you should provide guidance to your coding staff to ensure that they do not continue to use those codes. Some of your coding staff may use cheat sheets that they use to refer to ensure that they have an acceptable primary diagnosis as they code your charts. If they do use cheat sheets, you will need to make sure that those are updated. You also need to ensure that your EMR gets the current ICD-10 codes, that are acceptable as a PDGM primary diagnosis, loaded into your software system so you do not have coders that are incorrectly coding, and that you do not have claims that are going out with an unacceptable primary diagnosis. 

Comorbidity Subgroup Reclassification 

In addition to those 155 codes being removed, there are 37 comorbidity or secondary diagnoses that have been reclassified under the PDGM model. This means that they have been moved from one comorbidity subgroup to a different comorbidity subgroup. That does not mean that they have been removed from the list, but they have been reclassified.  This could mean that there is a change in the Case-Mix Weight impact depending on the combination, and especially in the high comorbidity adjustment, where you must have at least two secondary diagnoses that qualify. The number of low comorbidity subgroups increased from 20 to 22 and the high comorbidity subgroup interactions from 87 combinations to 91 in 2023.  

Part of this change includes putting the COVID-19 diagnosis code and related codes into a respiratory category that will trigger comorbidity adjustments. In addition, there are at least two primary diagnoses on the primary list that are being reclassified. One is being moved from the wound care section to an infectious disease section. The second is being moved from MMTA Other to MMTA Gastro. Make sure to note these specific changes that have been outlined in the final rule to ensure that you have the accurate information needed both in your EMR system, and that your coders are aware of the changes to the primary diagnosis and the secondary/comorbidity adjustments.  

Introduction of Three New G-Codes for Telehealth 

There are three new G-Codes that have been introduced to support Telecommunication Services. Telehealth being provided via two-way audio/video, telehealth that is audio only, and remote patient monitoring. Keep in mind that these telehealth codes are for information purposes only and they will not change your payment. You will not be paid for telehealth services, but these codes are going to be implemented in the billing process so that they can collect data and eventually get us to the point of receiving payment through the Medicare Home Health benefit specific to telehealth services.  

If you have any questions or require help, reach out to us We are here to help you with your coding needs.