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Z47.81 (Encounter for orthopedic aftercare following surgical amputation) was the least profitable primary diagnosis in home health through the first three quarters of 2018. The average reimbursement per episode was $3,031, while the average cost per episode was $2,907.
The data represent about 700,000 PPS episodes that ended between January 2018 and September 2018. The care was provided by more than 1,000 provider locations nationwide.
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ICD-10 codes and description
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Average margin per standard episode
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Average skilled nursing visits per episode
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Average therapy visits per episode
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Average costs per episode
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Average reimbursement per episode
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Z47.81 (Encounter for orthopedic aftercare following surgical amputation)
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5.3%
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11.3
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7.1
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$2,907
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$3,031
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E11.621 (Type 2 diabetes mellitus with foot ulcer)
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5.4%
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14.0
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3.1
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$2,564
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$2,658
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I87.2 (Venous insufficiency (chronic) (peripheral))
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6.3%
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13.7
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3.5
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$2,654
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$2,816
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I13.0 (Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease)
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13.9%
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9.0
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7.2
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$2,593
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$2,895
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J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation)
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14.9%
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8.6
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7.5
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$2,619
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$2,957
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J44.0 (Chronic obstructive pulmonary disease with acute lower respiratory infection)
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15.8%
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8.8
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7.9
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$2,628
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$3,004
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I69.354 (Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side)
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15.8%
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5.9
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16.0
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$3,701
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$4,217
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I69.351 (Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side)
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16.3%
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5.9
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16.1
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$3,704
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$4,280
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I48.0 (Paroxysmal atrial fibrillation)
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16.9%
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8.7
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7.8
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$2,572
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$2,926
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N39.0 (Urinary tract infection, site not specified)
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16.9%
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8.2
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8.1
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$2,646
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$3,048
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Source: Minneapolis-based ABILITY Network
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