Diagnosis excluded under HHGM

Is anyone aware of a list of diagnosis's that are excluded under HHGM?


  • I've been delving into the new payment system. The primary diagnosis has to fall into 6 different categories, and the ones that are considered to be "questionable encounter" codes, which don't fall into the six categories, seem to be any code with the word "unspecified", any R codes, and for some reason the codes relating to Stage 5 and end stage renal disease, including the hypertension codes related to stage 5 and ES renal disease. (I am hoping this is a mistake and will get sorted out). Also, Z466 is not acceptable as a primary diagnosis. I'm hoping that one is a mistake too. Oh, and N390, because it has the word unspecified! We will also get additional reimbursement for co-morbidities. I know it's early, but I can see lots of possible problems with physician documentation. They are not specific enough now, and it will be completely unacceptable with HHGM. We are going to need more specific diagnoses in order to get paid. We are getting an early start and are already looking to retraining our intake department, clinicians, and coders

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