The service that will be providing the
most care to the patient should be listed as primary.
From 3M OASIS Integrity Project: http://www.nahc.org/NAHC/LegReg/3MNOIP.pdf
Recommendations from Expert Design Forum
Optimal Question: Primary diagnosis: What diagnosis is driving the home health plan of care?
Secondary Diagnoses: What diagnoses are addressed by the home health plan of care or have the potential to affect the plan of care, affect progress and rehabilitationpotential or justify all services provided?
Optimal Technique: Determine diagnostic statements after completion of assessment, determining patient’s needs and formulation of home health plan of care.
Tips:
Follow ICD coding guidelines (www.cdc.gov/nchs/data/icd9/icdguide.pdf) and use current coding books.
Follow directions in Home Health Agency Manual #11 (Sec. 234.7 (11-13).
Refer to CMS guidance document, "Diagnosis Coding for Medicare Home Health under PPS", (
cms.hhs.gov/providers/hhapps/hhdiag.pdf) for examples.
Refer to CMS OASIS Implementation Manual, Chapter 8, Attachment D for the use of v-codes.
Primary Diagnosis:
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Diagnosis most related to the current plan of care developed by the agency.
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Represents the most acute condition and most intensive services.
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May not be related to the reason for hospitalization.
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May be best described by a v-code.
Secondary Diagnoses:
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Conditions addressed by the plan of care.
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Conditions that coexist and have the potential to affect the plan of care.
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Justify disciplines and services rendered.
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May be described as a V- or E-code.
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Two examples:
Mr Smith has dx of CHF which resulted in 2 hospitalizations in the past month, DJD, unsteady gait discharged with new cane. Services requested RN and PT
RN eval reveals 10 medications, four new, multiple old meds from three years ago in the home. Pt was able to walk upstairs easily with cane to show RN bathroom for safety eval.
RN expects nursing to be in longer than PT so CHF is listed as primary diagnosis.
Miss Eisenhower has dx of CHF, treated with one dose IV lasix, DJD and is status post knee replacement. Orders for RN to remove staples in five days, PT for home exercise program
RN eval reveals pt on 4 meds; knowledgable about purpose, schedule and side effects. Current RX recently refilled in the home. Pt able to describe NAS diet + meal plan. Follows writtenmed schedule posted on refrigerator. Pt states told she went into mild CHF due amount of fluids used in operation. ambulatory with new walker, only 20 feet in home and has first floor powder room.
RN expects nursing in only for 2-3 further visits but needs extensive PT.
PT Aftercare of surgery, DJD then CHF listed.
If its a tossup, then list SN as primary.
Would you like to comment?
I've had it placed in my brain and gold-plated, so now I've gotta train myself back out of it! Even the Palmetto GBA manual CLEARLY states:
