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
|Rank||ICD-10 code||ICD-10 description||% of claims - total patients||Explore dataset|
|1||I10||Essential (primary) hypertension||3.30%||Explore|
|2||M6281||Muscle weakness (generalized)||2.90%||Explore|
|4||R262||Difficulty in walking, not elsewhere classified||1.50%||Explore|
|5||K219||Gastro-esophageal reflux disease without esophagitis||1.40%||Explore|
|6||E119||Type 2 diabetes mellitus without complications||1.30%||Explore|
|8||I2510||Atherosclerotic heart disease of native coronary artery without angina pectoris||1.00%||Explore|
|9||J449||Chronic obstructive pulmonary disease, unspecified||1.00%||Explore|
|11||R2689||Other abnormalities of gait and mobility||1.00%||Explore|
|12||R2681||Unsteadiness on feet||0.90%||Explore|
|14||F419||Anxiety disorder, unspecified||0.90%||Explore|
|15||F0390||Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety||0.80%||Explore|
|16||N390||Urinary tract infection, site not specified||0.80%||Explore|
|17||Z741||Need for assistance with personal care||0.80%||Explore|
|19||R41841||Cognitive communication deficit||0.80%||Explore|
|20||R1312||Dysphagia, oropharyngeal phase||0.80%||Explore|
|21||I4891||Unspecified atrial fibrillation||0.70%||Explore|
|22||R278||Other lack of coordination||0.70%||Explore|
|23||Z9181||History of falling||0.70%||Explore|
|25||I509||Heart failure, unspecified||0.60%||Explore|
|26||N179||Acute kidney failure, unspecified||0.50%||Explore|
|28||I739||Peripheral vascular disease, unspecified||0.50%||Explore|
|31||M1990||Unspecified osteoarthritis, unspecified site||0.50%||Explore|
|32||F339||Major depressive disorder, recurrent, unspecified||0.40%||Explore|
|34||R269||Unspecified abnormalities of gait and mobility||0.40%||Explore|
|35||F329||Major depressive disorder, single episode, unspecified||0.40%||Explore|
|36||N1830||Chronic kidney disease, stage 3 unspecified||0.40%||Explore|
|37||I480||Paroxysmal atrial fibrillation||0.40%||Explore|
|38||J189||Pneumonia, unspecified organism||0.40%||Explore|
|39||Z23||Encounter for immunization||0.40%||Explore|
|41||E6601||Morbid (severe) obesity due to excess calories||0.40%||Explore|
|42||Z8616||Personal history of COVID-19||0.40%||Explore|
|43||E559||Vitamin D deficiency, unspecified||0.40%||Explore|
|45||J9601||Acute respiratory failure with hypoxia||0.40%||Explore|
|46||E46||Unspecified protein-calorie malnutrition||0.40%||Explore|
|47||R279||Unspecified lack of coordination||0.30%||Explore|
|49||I639||Cerebral infarction, unspecified||0.30%||Explore|
|50||G4733||Obstructive sleep apnea (adult) (pediatric)||0.30%||Explore|
What are the most common skilled nursing facility diagnoses?
The top condition on our list is essential (primary) hypertension, with 3.30% of claims. This makes sense since nearly one in two adults in the U.S. has hypertension.
In second is muscle weakness (generalized), with 2.9%, followed by hyperlipidemia, unspecified, with 2.0%. In the U.S., 11.4% of adults have hyperlipidemia or high cholesterol.
Unsurprisingly, COVID-19 is high on the list in seventh place. 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.
Other common diagnoses at SNFs include respiratory illnesses such as pneumonia and COPD, neurological disorders such as dementia, and 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 be more of 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.
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