Home Health Diagnosis Codes Grouper Update for 4/1/2023

Effective 4/1/2023, CMS is implementing new HH Grouper edits. The HH Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating payment groups on HH claims.

With this implementation, CMS finalized the reassignment of 155 additional ICD-10-CM diagnosis codes from their current assigned clinical group to ‘NA’ when the codes are listed as a principal diagnosis. We remind HHAs that if a claim cannot be assigned a clinical group (NA), the claim will be returned to the provider for correction. The CY 2023 Final Home Health Clinical Group and Comorbidity Adjustment Diagnosis List provides the clinical grouping of HH diagnosis codes, and all codes identified as NA cannot be used as a principal diagnosis on a HH claim.

These new Grouper edits apply to Types of Bill 032X (except 032A, 032D, and 0320). With this process, we may return some claims to you with one of the following messages:

Unacceptable primary diagnosis, not reportable as primary
Manifestation code not reportable as primary diagnosis
Unspecified diagnosis code not acceptable as primary diagnosis
External cause of injury code not reportable as primary diagnosis
Primary diagnosis code is not valid for claim dates or is blank

Home Health Diagnosis Codes Grouper Update for 4/1/2023

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