Top 50 Skilled Nursing Facilities Diagnoses

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 20 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 most common and highest reimbursed ICD-10 code at SNFs is Z5189 – encounter for other specified aftercare. This code, 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 S72142D – Displaced fracture of left femur, subsequent encounter. Hip dislocations 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 Diagnoses at Skilled Nursing Facilities by ICD-10 Code

  1. Z5189: Encounter for other specified aftercare
  2. M6281: Generalized muscle weakness
  3. J189: Pneumonia
  4. N390: Urinary tract infection
  5. Z471: Aftercare following joint replacement

To learn more, download The Definitive List: Top 50 SNF Diagnoses by filling out the form on the right! 

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