PDPM Calculator
General
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Wichita Falls, TX
Wichita, KS
Wildwood-The Villages, FL
Williamsport, PA
Wilmington, DE-MD-NJ
Wilmington, NC
Winchester, VA-WV
Winston-Salem, NC
Worcester, MA-CT
Yakima, WA
York-Hanover, PA
Youngstown-Warren-Boardman, OH-PA
Yuba City, CA
Yuma, AZ
Resident Name:
Primary SNF Diagnosis (I0020B):
Prior Surgical Procedure:
No Surgical Procedure
Non-Orthopedic Surgery
Orthopedic Surgery (Except MJR or Spinal Surgery)
Major Joint Replacement or Spinal Surgery
Section GG - Admission Status
A.
Eating:
The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
B.
Oral hygiene:
The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
C.
Toileting hygiene:
The ability to maintain perineal hygiene, adjust cloths before and after voidng or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
B.
Sit to lying:
The ability to move from sitting on side of bed to lying flat on the bed.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
C.
Lying to sitting on side of bed:
The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
D.
Sit to stand:
The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
E.
Chair/bed-to-chair transfer:
The ability to transfer to and from a bed to a chair (or wheelchair).:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
F.
Toilet transfer:
The ability to get on and off a toilet or commode.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
J.
Walk 50 feet with two turns:
Once standing, the ability to walk at least 50 feet and make two turns.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
K.
Walk 150 feet:
Once standing, the ability to walk at least 150 feet in a corridor or similar space.:
01-Dependent
02-Substantial/maximal assistance
03-Partial/moderate assistance
04-Supervision or touching assistance
05-Setup or clean-up assistance
06-Independent
07-Resident Refused
09-Not applicable
10-Not attempted due to environmental limitations
88-Not attempted due to medical condition or safety concerns
SLP
SLP-Related Comorbidity:
Cognitive Impairment:
Swallowing Disorder:
Mechanically Altered Diet:
Nursing
Nursing Classification:
--select--
Extensive Services
Special Care High
Special Care Low
Clinically Complex
Behavioral Symptoms and Cognitive Performance
Reduced Physical Function
Additional Info:
Tracheostomy and Ventilator  
Tracheostomy or Ventilator  
Infection Isolation
Additional Info:
Depressed  
Not Depressed
Additional Info:
Restorative Nursing Services (2 or More)  
Restorative Nursing Services (0 - 1)
Non-Therapy Ancillary
HIV/AIDS (SNF Claim ICD-10 B20):
Parenteral IV Feeding: Level High (K0510A2 K0710A2):
Special Treatments/Programs: Intravenous Medication Post-admit Code (O0100H2 ):
Special Treatments/Programs: Ventilator Post-admit Code (O0100F2 ):
Parenteral IV feeding: Level Low (K0510A2 K0710A2 K0710B2):
Lung Transplant Status (I8000):
Special Treatments/Programs: Transfusion Post-admit Code (O0100I2 ):
Major Organ Transplant Status, Except Lung (I8000):
Active Diagnoses: Multiple Sclerosis Code (I5200 ):
Opportunistic Infections (I8000):
Active Diagnoses: Asthma COPD Chronic Lung Disease Code (I6200 ):
Bone/Joint/Muscle Infections/Necrosis - Except: Aseptic Necrosis of Bone (I8000):
Chronic Myeloid Leukemia (I8000):
Wound Infection Code (I2500 ):
Active Diagnoses: Diabetes Mellitus (DM) Code (I2900 ):
Endocarditis (I8000):
Immune Disorders (I8000):
End-Stage Liver Disease (I8000):
Other Foot Skin Problems: Diabetic Foot Ulcer Code (M1040B ):
Narcolepsy and Cataplexy (I8000):
Cystic Fibrosis (I8000):
Special Treatments/Programs: Tracheostomy Post-admit Code (O0100E2 ):
Active Diagnoses: Multi-Drug Resistant Organism (MDRO) Code (I1700 ):
Special Treatments/Programs: Isolation Post-admit Code (O0100M2 ):
Specified Hereditary Metabolic/Immune Disorders (I8000):
Morbid Obesity (I8000):
Special Treatments/Programs: Radiation Post-admit Code (O0100B2 ):
Highest Stage of Unhealed Pressure Ulcer - Stage 4 (M0300X1 ):
Psoriatic Arthropathy and Systemic Sclerosis (I8000):
Chronic Pancreatitis (I8000):
Proliferative Diabetic Retinopathy and Vitreous Hemorrhage (I8000):
Other Foot Skin Problems: Foot Infection Code, Other Open Lesion on Foot Code, Except Diabetic Foot (M1040A M1040B M1040C ):
Complications of Specified Implanted Device or Graft (I8000):
Bladder and Bowel Appliances: Intermittent catheterization (H0100D ):
Inflammatory Bowel Disease (I8000):
Aseptic Necrosis of Bone (I8000):
Special Treatments/Programs: Suctioning Post-admit Code (O0100D2 ):
Cardio-Respiratory Failure and Shock (I8000):
Myelodysplastic Syndromes and Myelofibrosis (I8000):
Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory Spondylopathies (I8000):
Diabetic Retinopathy - Except : Proliferative Diabetic Retinopathy and Vitreous Hemorrhage (I8000):
Nutritional Approaches While a Resident: Feeding Tube (K0510B2 ):
Severe Skin Burn or Condition (I8000):
Intractable Epilepsy (I8000):
Active Diagnoses: Malnutrition Code (I5600 ):
Disorders of Immunity - Except : RxCC97: Immune Disorders (I8000):
Cirrhosis of Liver (I8000):
Bladder and Bowel Appliances: Ostomy (H0100C ):
Respiratory Arrest (I8000):
Pulmonary Fibrosis and Other Chronic Lung Disorders (I8000):