HIPPS code

HIPPS codes are how a prospective payment group reaches a claim. A standard patient assessment is run through grouping software, the software assigns a case-mix group, and at least one HIPPS code stands for each group. CMS created the codes for the skilled nursing facility payment system in 1998, added home health codes in October 2000 and inpatient rehabilitation codes in January 2002, and maintains them as a non-medical code set under HIPAA, valid by transaction date. TRICARE uses them too, and so have certain state Medicaid programs.

Each system’s codes ride on its own revenue code: 0022 for skilled nursing facilities, 0023 for home health and 0024 for inpatient rehabilitation. On the UB-04 the code goes in form locator 44; on the 837I it goes in SV202 with the HP qualifier, with the revenue code in SV201. The positions mean different things in each system. A home health code reads source and timing, clinical group, functional level, comorbidity level and a fifth position held for future use. A skilled nursing code under PDPM reads the PT and OT group, the speech-language pathology group, the nursing group, the non-therapy ancillary group and the assessment indicator.

Who builds the code differs as well. A skilled nursing facility groups its own Minimum Data Set assessment and reports the result. A home health agency may put any valid HIPPS code on its single 0023 line, because Medicare’s grouper works out the code from the claim and OASIS data during processing and replaces the submitted one as needed. The mistake in both settings is billing before the assessment behind the code is complete, accepted and dated the way the claim says.