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 claims - total patientsExplore dataset
1I10Essential (primary) hypertension3.30%Explore
2M6281Muscle weakness (generalized)2.90%Explore
3E785Hyperlipidemia, unspecified2.00%Explore
4R262Difficulty in walking, not elsewhere classified1.50%Explore
5K219Gastro-esophageal reflux disease without esophagitis1.40%Explore
6E119Type 2 diabetes mellitus without complications1.30%Explore
8I2510Atherosclerotic heart disease of native coronary artery without angina pectoris1.00%Explore
9J449Chronic obstructive pulmonary disease, unspecified1.00%Explore
10D649Anemia, unspecified1.00%Explore
11R2689Other abnormalities of gait and mobility1.00%Explore
12R2681Unsteadiness on feet0.90%Explore
13E039Hypothyroidism, unspecified0.90%Explore
14F419Anxiety disorder, unspecified0.90%Explore
15F0390Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety0.80%Explore
16N390Urinary tract infection, site not specified0.80%Explore
17Z741Need for assistance with personal care0.80%Explore
19R41841Cognitive communication deficit0.80%Explore
20R1312Dysphagia, oropharyngeal phase0.80%Explore
21I4891Unspecified atrial fibrillation0.70%Explore
22R278Other lack of coordination0.70%Explore
23Z9181History of falling0.70%Explore
24K5900Constipation, unspecified0.60%Explore
25I509Heart failure, unspecified0.60%Explore
26N179Acute kidney failure, unspecified0.50%Explore
27G4700Insomnia, unspecified0.50%Explore
28I739Peripheral vascular disease, unspecified0.50%Explore
29F32ADepression, unspecified0.50%Explore
30B351Tinea unguium0.50%Explore
31M1990Unspecified osteoarthritis, unspecified site0.50%Explore
32F339Major depressive disorder, recurrent, unspecified0.40%Explore
33R296Repeated falls0.40%Explore
34R269Unspecified abnormalities of gait and mobility0.40%Explore
35F329Major depressive disorder, single episode, unspecified0.40%Explore
36N1830Chronic kidney disease, stage 3 unspecified0.40%Explore
37I480Paroxysmal atrial fibrillation0.40%Explore
38J189Pneumonia, unspecified organism0.40%Explore
39Z23Encounter for immunization0.40%Explore
40R1310Dysphagia, unspecified0.40%Explore
41E6601Morbid (severe) obesity due to excess calories0.40%Explore
42Z8616Personal history of COVID-190.40%Explore
43E559Vitamin D deficiency, unspecified0.40%Explore
44R5381Other malaise0.40%Explore
45J9601Acute respiratory failure with hypoxia0.40%Explore
46E46Unspecified protein-calorie malnutrition0.40%Explore
47R279Unspecified lack of coordination0.30%Explore
49I639Cerebral infarction, unspecified0.30%Explore
50G4733Obstructive sleep apnea (adult) (pediatric)0.30%Explore

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

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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