The growing population of elderly patients and their higher share of overall health spending have made skilled nursing facilities (SNFs) an increasingly important part of the healthcare continuum. SNFs provide essential care to elderly patients and, more specifically, Medicare beneficiaries. There are currently 67.7 million Medicare beneficiaries in the U.S.
This list identifies the top 50 SNF diagnoses ranked by total payments.
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| Rank | ICD-10 Code | ICD-10 Description | Total Claims | Avg Payment Per Claim | Total Payments | Explore These Claims |
| 1 | N390 | Urinary tract infection, site not specified | 135,950 | $6,182 | $840,503,948 | Explore This Code |
| 2 | J189 | Pneumonia, unspecified organism | 122,039 | $6,004 | $732,778,295 | Explore This Code |
| 3 | Z471 | Aftercare following joint replacement surgery | 96,026 | $6,351 | $609,894,663 | Explore This Code |
| 4 | A419 | Sepsis, unspecified organism | 82,965 | $6,372 | $528,655,595 | Explore This Code |
| 5 | Z4789 | Encounter for other orthopedic aftercare | 66,978 | $6,992 | $468,307,387 | Explore This Code |
| 6 | I639 | Cerebral infarction, unspecified | 66,736 | $6,625 | $442,109,752 | Explore This Code |
| 7 | M6281 | Muscle weakness (generalized) | 67,236 | $5,738 | $385,800,827 | Explore This Code |
| 8 | J441 | Chronic obstructive pulmonary disease with (acute) exacerbation | 64,953 | $5,907 | $383,676,801 | Explore This Code |
| 9 | J449 | Chronic obstructive pulmonary disease, unspecified | 61,781 | $5,360 | $331,134,407 | Explore This Code |
| 10 | G9341 | Metabolic encephalopathy | 50,259 | $6,467 | $325,011,627 | Explore This Code |
| 11 | Z5189 | Encounter for other specified aftercare | 45,732 | $7,008 | $320,481,410 | Explore This Code |
| 12 | I509 | Heart failure, unspecified | 52,297 | $5,453 | $285,180,830 | Explore This Code |
| 13 | R531 | Weakness | 32,086 | $8,801 | $282,390,389 | Explore This Code |
| 14 | J9601 | Acute respiratory failure with hypoxia | 46,136 | $6,117 | $282,217,162 | Explore This Code |
| 15 | S72001D | Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing | 36,282 | $7,159 | $259,741,139 | Explore This Code |
| 16 | I10 | Essential (primary) hypertension | 45,538 | $5,651 | $257,316,574 | Explore This Code |
| 17 | N179 | Acute kidney failure, unspecified | 43,181 | $5,866 | $253,316,721 | Explore This Code |
| 18 | S72002D | Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing | 34,081 | $7,143 | $243,444,434 | Explore This Code |
| 19 | G20 | Parkinson's disease | 41,716 | $5,781 | $241,142,719 | Explore This Code |
| 20 | S72142D | Displaced intertrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing | 32,132 | $7,437 | $238,978,654 | Explore This Code |
| 21 | S72141D | Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing | 28,914 | $7,481 | $216,300,840 | Explore This Code |
| 22 | G9340 | Encephalopathy, unspecified | 34,408 | $6,202 | $213,390,412 | Explore This Code |
| 23 | I4891 | Unspecified atrial fibrillation | 36,017 | $5,577 | $200,868,670 | Explore This Code |
| 24 | I5033 | Acute on chronic diastolic (congestive) heart failure | 34,882 | $5,731 | $199,923,136 | Explore This Code |
| 25 | Z48815 | Encounter for surgical aftercare following surgery on the digestive system | 29,813 | $6,368 | $189,859,637 | Explore This Code |
| 26 | I69354 | Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side | 26,462 | $7,122 | $188,453,166 | Explore This Code |
| 27 | N186 | End stage renal disease | 33,934 | $5,351 | $181,591,634 | Explore This Code |
| 28 | I69351 | Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side | 23,916 | $7,188 | $171,917,527 | Explore This Code |
| 29 | I214 | Non-ST elevation (NSTEMI) myocardial infarction | 29,732 | $5,743 | $170,738,495 | Explore This Code |
| 30 | L03115 | Cellulitis of right lower limb | 24,844 | $6,684 | $166,067,371 | Explore This Code |
| 31 | R55 | Syncope and collapse | 27,218 | $6,093 | $165,836,885 | Explore This Code |
| 32 | Z4781 | Encounter for orthopedic aftercare following surgical amputation | 22,792 | $7,225 | $164,661,672 | Explore This Code |
| 33 | L03116 | Cellulitis of left lower limb | 24,248 | $6,701 | $162,489,986 | Explore This Code |
| 34 | Z48812 | Encounter for surgical aftercare following surgery on the circulatory system | 25,731 | $6,207 | $159,704,464 | Explore This Code |
| 35 | J690 | Pneumonitis due to inhalation of food and vomit | 24,162 | $6,113 | $147,701,810 | Explore This Code |
| 36 | J9621 | Acute and chronic respiratory failure with hypoxia | 23,638 | $6,231 | $147,278,555 | Explore This Code |
| 37 | R5381 | Other malaise | 13,424 | $9,419 | $126,445,673 | Explore This Code |
| 38 | I2510 | Atherosclerotic heart disease of native coronary artery without angina pectoris | 23,805 | $5,287 | $125,847,194 | Explore This Code |
| 39 | F0390 | Unspecified dementia without behavioral disturbance | 37,627 | $3,089 | $116,219,421 | Explore This Code |
| 40 | J181 | Lobar pneumonia, unspecified organism | 18,317 | $6,217 | $113,881,202 | Explore This Code |
| 41 | I5023 | Acute on chronic systolic (congestive) heart failure | 20,192 | $5,616 | $113,407,010 | Explore This Code |
| 42 | K922 | Gastrointestinal hemorrhage, unspecified | 20,923 | $5,180 | $108,375,821 | Explore This Code |
| 43 | J9600 | Acute respiratory failure, unspecified whether with hypoxia or hypercapnia | 15,054 | $7,071 | $106,448,081 | Explore This Code |
| 44 | M6282 | Rhabdomyolysis | 15,407 | $6,713 | $103,421,811 | Explore This Code |
| 45 | I480 | Paroxysmal atrial fibrillation | 18,239 | $5,600 | $102,130,232 | Explore This Code |
| 46 | R4182 | Altered mental status, unspecified | 18,213 | $5,449 | $99,246,497 | Explore This Code |
| 47 | A0472 | Enterocolitis due to Clostridium difficile, not specified as recurrent | 14,800 | $6,603 | $97,721,044 | Explore This Code |
| 48 | D649 | Anemia, unspecified | 16,363 | $5,642 | $92,322,553 | Explore This Code |
| 49 | E119 | Type 2 diabetes mellitus without complications | 16,522 | $5,009 | $82,751,919 | Explore This Code |
| 50 | J9620 | Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia | 11,620 | $7,058 | $82,016,069 | Explore This Code |
Fig. 1 Data from Definitive Healthcare’s Long-Term Care database (accessed June 2020). Annual Medicare Data is from the Centers for Medicare and Medicaid Services (CMS) Medicare Standard Analytical Files (SAF). Complete calendar year data is projected to be released each fall by the CMS. The most recent annual Medicare data is from calendar year 2018; 2019 data is scheduled to be released in Fall 2020.
Urinary tract infections (UTIs) (N390) are the number one most diagnosed ailment at SNFs with 135,950 diagnoses in total. For some time now, UTIs have been reported as one of the most common long-term care facility infections. This is unfortunate because UTIs are an avoidable infection that continue to plague SNFs. Further, UTIs, if untreated, can result in sepsis (A419) — a fatal ailment with an approximate 40 percent mortality rate — which we see as the fourth most common diagnosis as per this list.
The second most commonly diagnosed ailment in SNFs is pneumonia (J189) with 122,039 total diagnoses. Pneumonia is understood to be another regular and challenging problem in nursing facilities. There are many different causes of pneumonia, but elderly patients in general are more prone to this illness.
Interestingly, the third most commonly reported ICD-10 code by SNFs is aftercare following joint replacement surgery (Z471). This means that a large amount of patients are receiving post-acute therapy at SNFs after their joint replacement surgeries, showing that SNFs are beneficial in the short-term (as well as the long-term) care of patients.