Healthcare Insights

Top 50 Skilled Nursing Facilities Diagnoses

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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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.

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