PDPM Calculator
General
Fiscal Year:
Urban or Rural:Urban   Rural
Use Wage Index?:
Wage Index:
Resident Name:
Primary SNF Diagnosis (I0020B):
Prior Surgical Procedure:
 
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.:
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.:
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.:
B. Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.:
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.:
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.:
E. Chair/bed-to-chair transfer: The ability to transfer to and from a bed to a chair (or wheelchair).:
F. Toilet transfer: The ability to get on and off a toilet or commode.:
J. Walk 50 feet with two turns: Once standing, the ability to walk at least 50 feet and make two turns.:
K. Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space.:
 
SLP
SLP-Related Comorbidity:
Cognitive Impairment:
Swallowing Disorder:
Mechanically Altered Diet:
Nursing
Nursing Classification:
 
 
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):