432
Total case-mix groups
12
Clinical groupings
3
Functional levels
30
Day payment periods
2
Admission sources
5 PDGM Case-Mix Variables
12 Clinical Groupings
⌕
Functional Impairment Levels
Comorbidity Adjustment
None
No qualifying secondary Dx
Low
1 qualifying secondary Dx
High
2+ interacting secondary Dx
High comorbidity requires two or more secondary diagnoses that interact with each other to produce higher resource use. CMS publishes the official comorbidity adjustment subgroup lists annually. Code all clinically relevant secondary diagnoses — each adds potential adjustment value.
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