Home Health Blogger

Hip Replacement: 2022 PDGM Utilization Guidelines

Posted by Melissa Cott on Mar 17, 2022

Hip replacement recovery for many patients will take place in the home. Hip replacement patients will likely receive formal physical therapy from home health and/or outpatient physical therapy.

Medicare Reimbursement for Total Hip Replacement

For home health providers providing hip replacement surgery recovery, the average Medicare reimbursement will be $1900 and $3000 for the 1st 30-day billing episode and $1200 to $2800 for the 2nd 30-day episode. Given the scope of services for a patient with fundamental mobility limitations, its important that resources - nursing and/or therapy and/or home health aide - are allocated appropriately.

Recommended Utilization for Patients with Daytime Caregiver Who is Teachable

Download Teaching Sheet for Anti-Embolism StockingsIdentifying a teachable caregiver is one of the most important steps to successful discharge and a profitable episode.

Patients with a teachable daytime caregiver enable the HHA to be more conservative with the number of visits provided as the caregiver can be taught signs and symptoms requiring a call to the physician, and preventive care to promote healing and recovery. In this scenario the services of home health aide and/or nursing may be avoided enabling the full episode to be allocated to physical and/or occupational therapy.

If the patient requires nursing (for co-morbidities that can't or won't be addressed by the therapist), the preferred utilization is 6 therapy and 4 nursing visits (HIPPS = 1EA11) to 12 therapy and 4 nursing (2EC31). If no nursing is provided, 10 to 16 therapy visits.

Utilization for Patients with No Caregiver

Hip replacement patients without a teachable caregiver will likely require many more services - including home health aide.

Preferred utilization is 6 therapy and 12 home health aide (HIPPS = 1EA11) to 10 therapy and 13 HHA (2EC31). 

Omission of Nursing

Under PDGM, home health agencies should assign therapists to perform monitoring of co-morbidities and - very importantly - provide comprehensive diagnosis-specific teaching resources so that nursing can be omitted

Patient Teaching: The Do's of Hip Surgery Recovery

Instruct the patient to: 

• Sit only in chairs with arms that can provide support when getting up.
• Wear anti embolism stockings (except when in bed at night).
• Keep the affected leg facing forward, whether sitting, lying down, or walking.
• Exercise regularly, as ordered. Stop exercising immediately if there is pain.
• Lie down and elevate feet and legs if they swell after walking.
• Rent or purchase a raised toilet seat for use at home, and use public toilets designated for the handicapped.
• Turn in bed only as directed by your doctor.
• Place a pillow between the legs when lying on the side and when going to bed at night. (This keeps the leg from twisting and dislodging the new hip.)
• Sit on a firm pillow when riding in a car, and keep the affected leg extended. (If the knee suddenly hits the dashboard the hip prosthesis could become dislodged.)

The Don'ts of Hip Surgery Recovery

Instruct the patient to avoid

• Leaning far forward to stand up.
• Sitting on low-chairs or couches.
• Bending way over when picking up objects or tying shoes. 
• Crossing the legs or turn the hip or knee inward or outward. This can be avoided by placing a pillow between the knees.
• Scrubbing the surgical incision.
• Taking a tub bath.
• Lifting heavy items.
• Sexual intercourse until the doctor gives permission.
• Running, jogging, or other strenuous activi­ties.
• Driving a car.
• Reaching to the end of the bed to pull the blankets up.

Call the Doctor if ...

• redness, swelling, or warmth around the incision
• drainage from the incision
• fever or chills
• severe hip pain uncontrolled by prescribed pain medicine
• sudden sharp pain and a clicking or popping sound in the joint
• leg shortening, with the foot turning outward
• loss of control over leg motion or complete loss of leg motion.

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