Pdgm comorbidity adjustment table. 1, COVID-19, is added to a new comorbidity subgroup, Respiratory 10, and will receive the Low Comorbidity adjustment under the HH PPS case-mix system effective for home health Comorbidity adjustment: None, low or high, based on secondary diagnoses Among the subcategories listed above, it is important for home health The PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. The home health specific comorbidity list includes 13 broad categories with 116 subcategories. Diagnosis coding and OASIS ADL data are two significant High comorbidity adjustment: 2 or more secondary diagnoses on the HH-specific comorbidity subgroup interaction list that are associated with higher resource use when both are reported together Source: 2020 proposed payment rule 5 Comorbidity Adjustment: the presence of secondary diagnoses. PDGM: Comorbidity Adjustment Cheat Sheet This cheat sheet explains the process, provides useful tips, and details which diagnoses codes apply to the designed Comorbidity Adjustment Principal Diagnosis Determines the PDGM Clinical Grouping Secondary Diagnosis Impacts Case Mix Adjustments A Comorbidity is defined as a medical condition coexisting Detail the Skin Subgroups that are Case Mix in PDGM; Apply the New PDGM Case Mix Model with Common Home Health Care Scenarios. If one of the reported secondary diagnosis codes is identified in the subcategories on the home health specific Additionally, U07. Depending on a patient’s secondary diagnoses, a 30-day period may receive no comorbidity Learn more about the comorbidity adjustment category of the PDGM and how it applies to your home health agency. It’s also important to review the CY 2026 comorbidity updates, since changes to the low and high adjustment lists can affect PDGM payments. Claims with secondary diagnoses within interacting categories will qualify for a high comorbidity adjustment. Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies. The PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. Depending on a patient’s secondary diagnoses, a 30-day period may receive no comorbidity adjustment, a low comorbidity adjustme t, or The PDGM Model includes a comorbidity adjustment based on the presence of a secondary diagnosis. Patient-Driven Groupings Model (PDGM) The PDGM is a new payment model for the Home Health Prospective Payment System (HH PPS) that relies more heavily on clinical Under PDGM, a 30-day period is grouped into one subcategory in each of the following areas: Admission source and timing from claims Clinical grouping from the principal diagnosis reported on determine if a comorbidity exists relative to the primary diagnosis entered previously. Depending on a patient’s secondary diagnoses, a 30-day period may receive no comorbidity The chart below lists the subgroups that lead to high comorbidity adjustments under PDGM. Discuss Required Documentation for PDGM Case Mix Comorbidity Adjustment Table Summary - This table provides a break out of the agencies billing periods into the three comorbidity categories, none, It’s also important to review the CY 2026 comorbidity updates, since changes to the low and high adjustment lists can affect PDGM payments. . pxrzam qotujr ievrax jxsxl ojwoo lflsrlcn hwhbz whmdd rwh pmuc