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THE PATIENT DRIVEN GROUPINGS MODEL

Beginning January 1st, 2020 CMS will implement the Patient Driven Grouping Model and will designate many diagnoses as questionable encounters. These diagnoses are non-covered and will not qualify patients for the home health benefit if used as the primary diagnosis. By some estimates up to 40% of the primary diagnoses currently used will be non-covered. For your convenience, we have listed the top 20 diagnoses that will no longer be covered as the primary diagnosis. (They may be covered as secondary diagnoses)

  • ICD M62.81: Muscle weakness (generalized)

  • ICD Z91.81: History of falling

  • ICD R26.89: Other abnormalities of gait and mobility

  • ICD R26.81: Unsteadiness on feet

  • ICD R29.6: Repeated falls

  • ICD R53.1: Weakness

  • ICD R29.6: Unspecified abnormalities of gait

  • ICD R26.2: Difficulty in walking, not elsewhere classified

  • ICD S72.001D: Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing

  • ICD S72.002D: Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing

  • ICD S81.801D: Unspecified open wound, right lower leg, subsequent encounter

  • ICD S81.802D: Unspecified open wound, left lower leg, subsequent encounter

  • ICD I13.2: Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease

  • ICD I12.0: Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease

  • ICD M19.90: Primary osteoarthritis, unspecified site

  • ICD M19.90: Unspecified osteoarthritis, unspecified site

  • ICD M06.9: Rheumatoid arthritis, unspecified

  • ICD C34.90: Malignant neoplasm of unspecified part of unspecified bronchus or lung

  • ICD Z46.6: Encounter for fitting and adjustment of urinary device

  • ICD R33.9: Retention of urine, unspecified

***The ICD-10 codes should be more specific rather than generalized.

In general, ICD-10 Codes should be more specific rather than generalized.

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