PDGM 30-Day Groupings

By Sharon Litwin January 10, 2020

30-day periods are placed into different subgroups for each of the following five categories:

1. Admission source (two subgroups):
• Community or
• Institutional admission source

2. Timing of the 30-day period (two subgroups):
• Early (first 30-day period) or
• Late (every subsequent payment period after the first period)

3. Clinical Grouping – 12 groups based on Primary Diagnosis Only
• Musculoskeletal Rehabilitation
• Neuro/Stroke Rehabilitation
• Wounds
• Behavioral Health Care
• Complex Nursing Interventions
• MMTA – Surgical Aftercare
• MMTA – Cardiac and Circulatory
• MMTA – Endocrine
• MMTA – Gastrointestinal Tract and Genitourinary System
• MMTA – Infectious Disease, Neoplasms, and Blood-Forming Diseases
• MMTA – Respiratory
• MMTA- Other

*Note – MMTA is Medication Management, Teaching and Assessment

4. Functional Impairment Level (3 subgroups)
Low, Medium, or High-based on the OASIS responses to:
• M1800 – grooming
• M1810 – upper body dressing
• M1820 – lower body dressing
• M1830 – bathing
• M1840 – toilet transferring
• M1850 – transferring
• M1860 – ambulation/locomotion
• M1033 – hospitalization risk – *excluding responses 8-reports exhaustion, 9-risk(s) not listed in 1-8, and 10-none of the above

5. Comorbidity Adjustment
• From Secondary Diagnosis Reported on Claims
o None
o Low
o High

Southern Web SupportPDGM 30-Day Groupings
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