Top 50 Diagnoses at Skilled Nursing Facilities

 

The growing population of elderly and their higher share of overall health spending have made skilled nursing care an increasingly important part of the healthcare continuum. Taking control of post-acute care can lower episodic costs and reduce the likelihood of avoidable conditions. In order to improve care, it’s necessary to understand the patient volumes and conditions that SNFs manage each day. The following list identifies the top 50 ICD-10 diagnoses by total payments.

Unlike in acute care settings, diagnosis coding in SNFs often reflects the cause of
admission to the referring hospital, rather than to the nursing facility itself. As a result, the second-most common ICD-10 code at SNFs is Z5189 – encounter for other specified aftercare. ICD-10 code Z5189 swapped places with ICD-10 code M6281, generalized muscle weakness, from 2016 to 2017. Code Z5189 , along with others in the Z range listed in the top 50, describes patients admitted to an SNF to receive follow-up care for an existing condition diagnosed and treated in a less-intensive environment, to manage post-hospital discharge ailments, or to prevent immediate recurrence. Most of the rest of the diagnoses are for conditions commonly associated with the elderly, such as pneumonia, heart failure, hip fracture, and mobility problems.

The code with the highest average payments per claim is S3289XB – Fracture of other parts of pelvis, initial encounter for open fracture. Hip fractures, displacements, and other major joint injuries typically involve a longer healing time and length of stay, contributing to the higher post-acute care spending and increased follow-up visits. The same is true for many of the other high-cost codes on the list, such as cerebral artery occlusion with cerebral infarction (stroke), neck or femur fracture, and care involving physical therapy (such as breathing exercises or training to regain mobility).

Top 5 SNF Diagnoses

  1. Generalized muscle weakness: 174,389
  2. Encounter for other specified aftercare: 152,501
  3. Pneumonia, unspecified: 155,950
  4. Urinary tract infection: 146,063
  5. Aftercare following joint replacement surgery: 99,798

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