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.

Top 50 most common ICD-10 codes for skilled nursing facilities by total payments

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RankICD-10 CodeICD-10 DescriptionTotal ClaimsAvg Payment Per ClaimTotal PaymentsExplore These Claims
1N390Urinary tract infection, site not specified135,950$6,182 $840,503,948 Explore This Code
2J189Pneumonia, unspecified organism122,039$6,004 $732,778,295 Explore This Code
3Z471Aftercare following joint replacement surgery96,026$6,351 $609,894,663 Explore This Code
4A419Sepsis, unspecified organism82,965$6,372 $528,655,595 Explore This Code
5Z4789Encounter for other orthopedic aftercare66,978$6,992 $468,307,387 Explore This Code
6I639Cerebral infarction, unspecified66,736$6,625 $442,109,752 Explore This Code
7M6281Muscle weakness (generalized)67,236$5,738 $385,800,827 Explore This Code
8J441Chronic obstructive pulmonary disease with (acute) exacerbation64,953$5,907 $383,676,801 Explore This Code
9J449Chronic obstructive pulmonary disease, unspecified61,781$5,360 $331,134,407 Explore This Code
10G9341Metabolic encephalopathy50,259$6,467 $325,011,627 Explore This Code
11Z5189Encounter for other specified aftercare45,732$7,008 $320,481,410 Explore This Code
12I509Heart failure, unspecified52,297$5,453 $285,180,830 Explore This Code
13R531Weakness32,086$8,801 $282,390,389 Explore This Code
14J9601Acute respiratory failure with hypoxia46,136$6,117 $282,217,162 Explore This Code
15S72001DFracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing36,282$7,159 $259,741,139 Explore This Code
16I10Essential (primary) hypertension45,538$5,651 $257,316,574 Explore This Code
17N179Acute kidney failure, unspecified43,181$5,866 $253,316,721 Explore This Code
18S72002DFracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing34,081$7,143 $243,444,434 Explore This Code
19G20Parkinson's disease41,716$5,781 $241,142,719 Explore This Code
20S72142DDisplaced intertrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing32,132$7,437 $238,978,654 Explore This Code
21S72141DDisplaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing28,914$7,481 $216,300,840 Explore This Code
22G9340Encephalopathy, unspecified34,408$6,202 $213,390,412 Explore This Code
23I4891Unspecified atrial fibrillation36,017$5,577 $200,868,670 Explore This Code
24I5033Acute on chronic diastolic (congestive) heart failure34,882$5,731 $199,923,136 Explore This Code
25Z48815Encounter for surgical aftercare following surgery on the digestive system29,813$6,368 $189,859,637 Explore This Code
26I69354Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side26,462$7,122 $188,453,166 Explore This Code
27N186End stage renal disease33,934$5,351 $181,591,634 Explore This Code
28I69351Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side23,916$7,188 $171,917,527 Explore This Code
29I214Non-ST elevation (NSTEMI) myocardial infarction29,732$5,743 $170,738,495 Explore This Code
30L03115Cellulitis of right lower limb24,844$6,684 $166,067,371 Explore This Code
31R55Syncope and collapse27,218$6,093 $165,836,885 Explore This Code
32Z4781Encounter for orthopedic aftercare following surgical amputation22,792$7,225 $164,661,672 Explore This Code
33L03116Cellulitis of left lower limb24,248$6,701 $162,489,986 Explore This Code
34Z48812Encounter for surgical aftercare following surgery on the circulatory system25,731$6,207 $159,704,464 Explore This Code
35J690Pneumonitis due to inhalation of food and vomit24,162$6,113 $147,701,810 Explore This Code
36J9621Acute and chronic respiratory failure with hypoxia23,638$6,231 $147,278,555 Explore This Code
37R5381Other malaise13,424$9,419 $126,445,673 Explore This Code
38I2510Atherosclerotic heart disease of native coronary artery without angina pectoris23,805$5,287 $125,847,194 Explore This Code
39F0390Unspecified dementia without behavioral disturbance37,627$3,089 $116,219,421 Explore This Code
40J181Lobar pneumonia, unspecified organism18,317$6,217 $113,881,202 Explore This Code
41I5023Acute on chronic systolic (congestive) heart failure20,192$5,616 $113,407,010 Explore This Code
42K922Gastrointestinal hemorrhage, unspecified20,923$5,180 $108,375,821 Explore This Code
43J9600Acute respiratory failure, unspecified whether with hypoxia or hypercapnia15,054$7,071 $106,448,081 Explore This Code
44M6282Rhabdomyolysis15,407$6,713 $103,421,811 Explore This Code
45I480Paroxysmal atrial fibrillation18,239$5,600 $102,130,232 Explore This Code
46R4182Altered mental status, unspecified18,213$5,449 $99,246,497 Explore This Code
47A0472Enterocolitis due to Clostridium difficile, not specified as recurrent14,800$6,603 $97,721,044 Explore This Code
48D649Anemia, unspecified16,363$5,642 $92,322,553 Explore This Code
49E119Type 2 diabetes mellitus without complications16,522$5,009 $82,751,919 Explore This Code
50J9620Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia11,620$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.