Healthcare Insights

Top 50 skilled nursing facilities diagnoses

Skilled nursing facilities (SNFs) play an increasingly important role in the healthcare continuum, particularly as the elderly patient population continues to grow. Definitive Healthcare tracks data on more than 20,000 skilled nursing facilities.

As SNFs frequently provide care to elderly patients and Medicare beneficiaries, we examined the most common diagnoses by both Medicare and commercial claims data.

50 most common ICD-10 codes for skilled nursing facilities by percentage of claims

RankICD-10 codeICD-10 description% of claimsExplore dataset
2G9341Metabolic encephalopathy3.30%Explore
3N390Urinary tract infection, site not specified2.92%Explore
4Z471Aftercare following joint replacement surgery1.81%Explore
5A419Sepsis, unspecified organism1.74%Explore
6J189Pneumonia, unspecified organism1.73%Explore
7G20Parkinson's disease1.64%Explore
8Z4789Encounter for other orthopedic aftercare1.63%Explore
9G9340Encephalopathy, unspecified1.60%Explore
10J449Chronic obstructive pulmonary disease, unspecified1.54%Explore
11J9601Acute respiratory failure with hypoxia1.53%Explore
12I639Cerebral infarction, unspecified1.49%Explore
13F0390Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety1.07%Explore
14M6259Muscle wasting and atrophy, not elsewhere classified, multiple sites0.95%Explore
15I69354Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side0.92%Explore
16J441Chronic obstructive pulmonary disease with (acute) exacerbation0.91%Explore
17N179Acute kidney failure, unspecified0.87%Explore
18S72002DFracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing0.84%Explore
19S72001DFracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing0.84%Explore
20I69351Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side0.83%Explore
21Z48815Encounter for surgical aftercare following surgery on the digestive system0.82%Explore
22Z4781Encounter for orthopedic aftercare following surgical amputation0.77%Explore
23S72142DDisplaced intertrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing0.76%Explore
24I509Heart failure, unspecified0.74%Explore
25R278Other lack of coordination0.73%Explore
26S72141DDisplaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing0.71%Explore
27I4891Unspecified atrial fibrillation0.68%Explore
28I5033Acute on chronic diastolic (congestive) heart failure0.59%Explore
29J9621Acute and chronic respiratory failure with hypoxia0.59%Explore
31G309Alzheimer's disease, unspecified0.56%Explore
32N186End stage renal disease0.54%Explore
33Z48812Encounter for surgical aftercare following surgery on the circulatory system0.53%Explore
34I214Non-ST elevation (NSTEMI) myocardial infarction0.52%Explore
35F0391Unspecified dementia, unspecified severity, with behavioral disturbance0.51%Explore
36E119Type 2 diabetes mellitus without complications0.47%Explore
37L03115Cellulitis of right lower limb0.46%Explore
38R55Syncope and collapse0.46%Explore
39L03116Cellulitis of left lower limb0.45%Explore
40I6930Unspecified sequelae of cerebral infarction0.42%Explore
41G35Multiple sclerosis0.42%Explore
42I2510Atherosclerotic heart disease of native coronary artery without angina pectoris0.40%Explore
43I5023Acute on chronic systolic (congestive) heart failure0.38%Explore
44I480Paroxysmal atrial fibrillation0.37%Explore
45J690Pneumonitis due to inhalation of food and vomit0.36%Explore
46D649Anemia, unspecified0.36%Explore
47I69398Other sequelae of cerebral infarction0.31%Explore
48S065X0DTraumatic subdural hemorrhage without loss of consciousness, subsequent encounter0.31%Explore
49S7291XDUnspecified fracture of right femur, subsequent encounter for closed fracture with routine healing0.30%Explore
50E871Hypo-osmolality and hyponatremia0.29%Explore

Fig. 1 Claims data is sourced from medical claims clearinghouses in the United States. Data is accurate as of October 2023.

What are the most common skilled nursing facility diagnoses?

The most common diagnosis in skilled nursing facilities is COVID-19, representing 9.33% of all SNF diagnosis claims filed. Long-term care facilities like SNFs were hit particularly hard at the start of the pandemic. As the SNF patient population tends to be elderly, most patients fall into the high-risk category for COVID-19.

Next on our list is metabolic encephalopathy, with 3.30% of SNF claims. Metabolic encephalopathies are a series of neurological disorders caused by chronic illnesses like heart disease, diabetes, and renal and respiratory failure. As our data demonstrates, patients with these conditions represent a considerable portion of SNF claims.

Urinary tract infections are the third most common diagnosis in SNFs, with 2.92% of claims. Urinary tract infections are not only among the most common infections in nursing homes, but they’re also among the most prevalent healthcare-acquired conditions.

Other common diagnoses at SNFs include respiratory illnesses such as pneumonia and COPD, neurological disorders such as dementia, and a variety of orthopedic conditions.

What is a skilled nursing facility (SNF)?

A skilled nursing facility is an inpatient facility that provides short- or long-term rehabilitation services. These facilities provide 24-hour licensed medical support to patients requiring transitional care following a qualifying hospital stay for illness, injury, or surgery.

The facilities primarily serve elderly patients and the majority of SNFs are Medicare-certified. Medicare beneficiaries are covered for up to 100 days in a SNF and face out-of-pocket costs for each additional day they spend in SNF care.

What qualifies a patient for skilled nursing care?

Patients who require skilled rehabilitative therapy or skilled nursing care typically qualify for a set number of days of skilled nursing care.

Under Medicare, beneficiaries are covered for SNF care if:

  • They have Medicare Part A and have days left in their benefit period available for use.
  • They were formally admitted to inpatient care at a hospital for three consecutive days.
  • They entered a Medicare-certified SNF within 30 days of leaving the hospital and receiving care for the same condition they were treated for during their hospital stay.
  • Their doctor has decided they required daily skilled care that needs to be received from, or under the supervision of skilled nursing or therapy staff.

Patients who required skilled nursing care can typically receive the following services at SNF facilities:

  • Medication management
  • Assistance with daily living activities
  • Meal preparation and dietary counseling
  • Wound care
  • Physical, occupational, and/or speech therapy
  • Cardiac rehabilitation
  • Post-stroke rehabilitation

What is the difference between a skilled nursing facility, assisted living, and a nursing home?

The biggest difference between skilled nursing facilities and assisted living facilities is that SNFs provide medical care while assisted living facilities provide more personal care in a home-like, social setting. Residents in an assisted living facility may only need moderate amounts of clinical care whereas those in skilled nursing require 24/7 care or rehabilitation services.

Skilled nursing facilities and nursing homes differ in that a nursing home tends to serve as a permanent residence for people who need long-term 24/7 care. SNFs are temporary residences for patients undergoing necessary rehabilitation or skilled nursing care, typically after a hospital stay, with a limited timeframe for care.

Learn more

Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.