BCHHC — Home Health Coding Certification

What is BCHHC?

The BCHHC (Board Certified Home Health Coder) is a professional certification for home health medical coders, offered by the Board of Medical Specialty Coding & Compliance (BMSCC). It validates expertise in ICD-10-CM coding for home health, OASIS assessments, and the PDGM payment model.

BCHHC Exam Overview

Detail	Info

|--------|------|

Certifying Body	BMSCC (Board of Medical Specialty Coding & Compliance)
Exam Format	Multiple choice, case-based scenarios
Prerequisites	Experience in home health coding recommended
Renewal	Every 2 years with continuing education
Focus Areas	ICD-10-CM, OASIS, PDGM, coding guidelines

Core Knowledge Areas

1. ICD-10-CM for Home Health

•Code structure and conventions (NEC, NOS, Excludes1, Excludes2)

•Principal/primary diagnosis selection

•Sequencing rules for home health setting

•Combination codes (HTN+HF+CKD, DM+CKD)

•Wound coding: pressure (L89), non-pressure (L97), post-surgical (T81)

•7th character selection: A (active treatment), D (subsequent), S (sequela)

2. OASIS Assessments

Type	Trigger	Timing

|------|---------|--------|

SOC	First skilled visit	Within 5 days
ROC	Returns from hospital	Within 24 hours
REC	Recertification	Near end of 60-day episode
SCIC	Acute change in condition	Within episode
DC	Discharge	At last visit

Who fills OASIS: SN (RN/LPN), PT, SLP — OT cannot fill independently.

3. PDGM — Patient-Driven Groupings Model

Five classification factors per 30-day payment period:

1.Timing — Early (1st period) vs Late (subsequent)

2.Admission source — Community vs Institutional (post-hospital)

3.Clinical grouping — 12 groups based on primary ICD-10-CM code

4.Functional level — Low/Medium/High from OASIS functional items

5.Comorbidity adjustment — None/Low/High from secondary diagnoses

12 PDGM Clinical Groups:

Musculoskeletal Rehab · Neuro/Stroke Rehab · Wound Care · Complex Medical/Surgical · Respiratory · Endocrine · Infectious Disease/Neoplasms · Cardiac/Circulatory · MMTA · Behavioural Health · Immobility · GI/GU

4. Homebound Documentation

•Leaving home requires considerable effort due to illness/injury

•Brief absences allowed: medical appointments, religious services, adult day care

•Must document specific limitation, distance/effort to leave, assistance needed

•Examples: SOB on exertion, non-weight-bearing, severe cognitive impairment

High-Yield Coding Scenarios

HTN + CHF + CKD Stage 3

I13.0   HTN with HF and CKD stages 1–4
I50.22  Chronic systolic heart failure
N18.3   CKD stage 3
Z79.4   Long-term insulin use (if applicable)

Never code I10 separately when I13.0 applies.

CVA Sequela in Home Health

I69.354  Hemiplegia left non-dominant (default if dominance not documented)
I69.320  Aphasia following cerebral infarction

Never code the acute stroke (I63-) — sequela codes imply post-infarction.

Wound Dehiscence with Wound VAC

T81.31XA  Disruption of external operation wound — 7th char A (active treatment)
Z48.89    Aftercare following surgery

Wound VAC present = active treatment = A. No wound VAC = D.

Diabetes Full Scenario

Patient: T2DM + CKD stage 3 + anemia of CKD + insulin

E11.22  T2DM with diabetic CKD
N18.3   CKD stage 3
D63.1   Anemia in CKD
Z79.4   Long-term insulin use

Exam Preparation Strategy

6-Week Study Plan

Week	Focus

|------|-------|

1–2	ICD-10-CM conventions, NEC/NOS, Excludes1/2, combination codes
3	OASIS types, timing, who fills, clinical documentation
4	PDGM — 5 factors, 12 clinical groups, LUPA thresholds
5	High-frequency coding scenarios: wounds, CVA, diabetes, HTN combos
6	Mock exams + timed practice cases

Key Resources

•AAPC Home Health coding curriculum

•CMS ICD-10-CM Official Guidelines (free on CMS.gov)

•CMS PDGM Final Rule and fact sheets

•OASIS Data Specifications (current version)

Practice Questions

Q: A patient had a stroke 4 months ago. She now has right hemiplegia (non-dominant). What code?

I69.351 — Hemiplegia and hemiparesis following cerebral infarction, right non-dominant side.

Q: Wound VAC is removed. Dressing changes only. Which 7th character?

D — Subsequent encounter. No active wound VAC = routine healing.

Q: OT evaluates a patient for home health. Can OT complete the OASIS?

No. OT cannot independently complete the OASIS. SN, PT, and SLP can.

Q: Patient has HTN + ESRD + CHF. Which combination code?

I13.11 — Hypertensive heart and chronic kidney disease, heart failure, ESRD.

Q: Primary diagnosis places patient in Wound Care clinical group. What is needed?

A wound-related primary ICD-10-CM code — such as L89.x (pressure ulcer), L97.x (non-pressure ulcer), or T81.31xD (surgical wound dehiscence).

Home Health Coding — certification