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 total Medicare payments
Rank |
ICD-10 Code |
ICD-10 Description |
# of Claims |
Avg Pmt/Claim |
Total Pmts |
Total Charges |
|
U071 |
COVID-19 |
241,611 |
$6,375 |
$1,540,286,133 |
$2,298,773,633 |
|
N390 |
Urinary tract infection, site not specified |
85,913 |
$6,778 |
$582,302,864 |
$871,886,834 |
|
G9341 |
Metabolic encephalopathy |
75,214 |
$7,552 |
$568,026,112 |
$790,136,975 |
|
A419 |
Sepsis, unspecified organism |
50,596 |
$7,585 |
$383,779,493 |
$531,386,915 |
|
Z4789 |
Encounter for other orthopedic aftercare |
49,300 |
$7,652 |
$377,240,679 |
$554,723,478 |
|
Z471 |
Aftercare following joint replacement surgery |
49,662 |
$7,267 |
$360,878,917 |
$517,827,144 |
|
J189 |
Pneumonia, unspecified organism |
50,595 |
$6,903 |
$349,260,803 |
$517,012,315 |
|
I639 |
Cerebral infarction, unspecified |
44,563 |
$7,459 |
$332,377,271 |
$512,084,652 |
|
G9340 |
Encephalopathy, unspecified |
42,662 |
$7,445 |
$317,615,897 |
$445,014,236 |
|
J9601 |
Acute respiratory failure with hypoxia |
39,968 |
$7,305 |
$291,970,308 |
$418,720,777 |
|
G20 |
Parkinson's disease |
43,191 |
$6,730 |
$290,690,830 |
$489,029,450 |
|
J449 |
Chronic obstructive pulmonary disease, unspecified |
42,888 |
$6,025 |
$258,399,026 |
$449,367,059 |
|
Z4781 |
Encounter for orthopedic aftercare following surgical amputation |
22,627 |
$8,190 |
$185,316,459 |
$265,533,164 |
|
I69354 |
Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side |
23,426 |
$7,712 |
$180,660,441 |
$295,400,162 |
|
S72002D |
Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing |
22,059 |
$7,942 |
$175,197,163 |
$255,819,791 |
|
Z48815 |
Encounter for surgical aftercare following surgery on the digestive system |
23,587 |
$7,346 |
$173,277,247 |
$250,877,209 |
|
S72001D |
Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing |
21,799 |
$7,933 |
$172,936,705 |
$255,772,501 |
|
J441 |
Chronic obstructive pulmonary disease with (acute) exacerbation |
24,343 |
$6,918 |
$168,407,593 |
$254,320,166 |
|
I69351 |
Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side |
21,185 |
$7,786 |
$164,945,721 |
$264,272,492 |
|
N179 |
Acute kidney failure, unspecified |
25,344 |
$6,376 |
$161,598,341 |
$253,382,262 |
|
S72142D |
Displaced intertrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing |
20,382 |
$7,877 |
$160,543,373 |
$244,827,744 |
|
R531 |
Weakness |
8,227 |
$18,761 |
$154,350,730 |
$223,437,144 |
|
S72141D |
Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing |
18,628 |
$7,985 |
$148,753,547 |
$226,691,032 |
|
I509 |
Heart failure, unspecified |
24,426 |
$6,038 |
$147,493,328 |
$245,830,476 |
|
M6259 |
Muscle wasting and atrophy, not elsewhere classified, multiple sites |
16,181 |
$7,906 |
$127,921,849 |
$159,782,153 |
|
R278 |
Other lack of coordination |
15,812 |
$8,047 |
$127,246,582 |
$162,113,036 |
|
F0390 |
Unspecified dementia without behavioral disturbance |
33,045 |
$3,753 |
$124,021,202 |
$360,999,291 |
|
I4891 |
Unspecified atrial fibrillation |
20,957 |
$5,833 |
$122,240,193 |
$210,274,145 |
|
J9621 |
Acute and chronic respiratory failure with hypoxia |
15,407 |
$7,491 |
$115,407,256 |
$173,542,517 |
|
M6282 |
Rhabdomyolysis |
14,534 |
$7,754 |
$112,697,000 |
$160,661,412 |
|
Z48812 |
Encounter for surgical aftercare following surgery on the circulatory system |
15,796 |
$7,088 |
$111,969,042 |
$163,079,236 |
|
L03115 |
Cellulitis of right lower limb |
14,218 |
$7,718 |
$109,734,556 |
$157,913,350 |
|
I5033 |
Acute on chronic diastolic (congestive) heart failure |
17,526 |
$6,129 |
$107,413,791 |
$173,477,619 |
|
L03116 |
Cellulitis of left lower limb |
13,894 |
$7,640 |
$106,149,347 |
$155,605,109 |
|
N186 |
End stage renal disease |
16,662 |
$6,153 |
$102,527,928 |
$164,095,342 |
|
I214 |
Non-ST elevation (NSTEMI) myocardial infarction |
15,369 |
$6,321 |
$97,154,052 |
$150,516,260 |
|
R5381 |
Other malaise |
4,367 |
$20,602 |
$89,969,884 |
$118,573,769 |
|
M545 |
Low back pain |
12,077 |
$7,417 |
$89,572,928 |
$129,573,196 |
|
R55 |
Syncope and collapse |
13,470 |
$6,359 |
$85,660,463 |
$134,526,050 |
|
E119 |
Type 2 diabetes mellitus without complications |
14,739 |
$5,628 |
$82,954,238 |
$159,150,115 |
|
F0391 |
Unspecified dementia with behavioral disturbance |
20,365 |
$4,032 |
$82,113,899 |
$211,405,105 |
|
J690 |
Pneumonitis due to inhalation of food and vomit |
11,301 |
$7,190 |
$81,254,883 |
$119,225,255 |
|
I6930 |
Unspecified sequelae of cerebral infarction |
9,728 |
$7,621 |
$74,141,172 |
$112,838,909 |
|
G92 |
Toxic encephalopathy |
9,270 |
$7,931 |
$73,522,930 |
$97,712,673 |
|
G35 |
Multiple sclerosis |
11,197 |
$6,471 |
$72,453,682 |
$129,976,565 |
|
D649 |
Anemia, unspecified |
11,352 |
$6,125 |
$69,527,947 |
$114,056,895 |
|
I2510 |
Atherosclerotic heart disease of native coronary artery without angina pectoris |
12,368 |
$5,450 |
$67,409,857 |
$128,304,341 |
|
S7291XD |
Unspecified fracture of right femur, subsequent encounter for closed fracture with routine healing |
8,356 |
$7,970 |
$66,594,424 |
$97,214,942 |
|
I5023 |
Acute on chronic systolic (congestive) heart failure |
10,268 |
$6,232 |
$63,985,434 |
$99,479,159 |
|
M869 |
Osteomyelitis, unspecified |
6,450 |
$9,805 |
$63,240,985 |
$79,802,660 |
Fig 1. – Data from the Definitive Healthcare LongTermCareView product. Data is for 2021 YTD through September. Annual Medicare data is from the Centers for Medicare and Medicaid (CMS) Medicare Standard Analytical Files (SAF). Complete calendar year data is projected be released each fall. which has an approximate 93% claims maturity for each quarter. Quarterly claims data is released by CMS approximately five to six months after the end of each quarter. New claims data is expected to be incorporated into the Definitive Healthcare database within 4-5 weeks. Data accessed April 2022.
50 most common ICD-10 codes for skilled nursing facilities by total charges to commercial payors
Rank |
ICD-10 Code |
ICD-10 Description |
# Total Diagnoses |
# Principal Diagnoses |
Total Charges |
|
U071 |
COVID-19 |
933,467 |
566,371 |
$1,852,820,891 |
|
J449 |
Chronic obstructive pulmonary disease, unspecified |
1,359,224 |
339,287 |
$1,027,708,704 |
|
F0390 |
Unspecified dementia without behavioral disturbance |
1,169,456 |
319,759 |
$1,021,860,249 |
|
I10 |
Essential (primary) hypertension |
4,370,070 |
677,926 |
$855,328,570 |
|
G309 |
Alzheimer's disease, unspecified |
402,948 |
192,010 |
$731,302,880 |
|
I639 |
Cerebral infarction, unspecified |
469,517 |
194,144 |
$697,838,109 |
|
N390 |
Urinary tract infection, site not specified |
733,524 |
224,039 |
$682,595,076 |
|
G20 |
Parkinson's disease |
388,461 |
170,485 |
$678,761,583 |
|
G9341 |
Metabolic encephalopathy |
244,925 |
105,936 |
$570,345,930 |
|
F0391 |
Unspecified dementia with behavioral disturbance |
441,553 |
155,846 |
$540,656,624 |
|
N186 |
End stage renal disease |
289,315 |
93,244 |
$512,707,538 |
|
A419 |
Sepsis, unspecified organism |
248,539 |
100,199 |
$479,496,173 |
|
E119 |
Type 2 diabetes mellitus without complications |
1,667,225 |
262,186 |
$479,182,429 |
|
J9601 |
Acute respiratory failure with hypoxia |
327,620 |
108,599 |
$435,203,153 |
|
M6281 |
Muscle weakness (generalized) |
2,846,241 |
349,956 |
$412,183,497 |
|
J189 |
Pneumonia, unspecified organism |
355,165 |
126,122 |
$389,672,715 |
|
G9340 |
Encephalopathy, unspecified |
208,969 |
77,016 |
$379,041,394 |
|
I69354 |
Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side |
191,517 |
76,029 |
$375,978,947 |
|
I509 |
Heart failure, unspecified |
666,353 |
144,268 |
$373,286,329 |
|
Z4789 |
Encounter for other orthopedic aftercare |
148,312 |
57,824 |
$367,511,494 |
|
I69351 |
Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side |
178,982 |
73,987 |
$360,506,839 |
|
J9610 |
Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia |
110,244 |
47,903 |
$313,390,969 |
|
G301 |
Alzheimer's disease with late onset |
173,413 |
90,786 |
$310,096,904 |
|
J441 |
Chronic obstructive pulmonary disease with (acute) exacerbation |
211,548 |
86,794 |
$308,928,561 |
|
G35 |
Multiple sclerosis |
137,652 |
74,757 |
$306,171,027 |
|
I2510 |
Atherosclerotic heart disease of native coronary artery without angina pectoris |
1,014,621 |
119,676 |
$305,596,315 |
|
Z471 |
Aftercare following joint replacement surgery |
78,456 |
45,969 |
$293,826,943 |
|
I4891 |
Unspecified atrial fibrillation |
799,124 |
117,298 |
$263,050,503 |
|
N179 |
Acute kidney failure, unspecified |
446,807 |
85,370 |
$261,478,337 |
|
Z4781 |
Encounter for orthopedic aftercare following surgical amputation |
47,484 |
30,932 |
$209,071,055 |
|
F209 |
Schizophrenia, unspecified |
248,337 |
71,195 |
$201,713,155 |
|
J9621 |
Acute and chronic respiratory failure with hypoxia |
112,410 |
46,101 |
$186,201,024 |
|
G311 |
Senile degeneration of brain, not elsewhere classified |
45,187 |
33,156 |
$180,518,247 |
|
J9611 |
Chronic respiratory failure with hypoxia |
148,797 |
46,673 |
$167,559,193 |
|
R1312 |
Dysphagia, oropharyngeal phase |
761,599 |
52,046 |
$164,801,849 |
|
S72002D |
Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing |
51,178 |
31,261 |
$164,270,446 |
|
S72001D |
Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing |
52,145 |
31,475 |
$161,896,099 |
|
Z48815 |
Encounter for surgical aftercare following surgery on the digestive system |
45,948 |
23,035 |
$157,798,509 |
|
D649 |
Anemia, unspecified |
1,001,722 |
102,388 |
$153,312,362 |
|
S72142D |
Displaced intertrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing |
36,987 |
24,558 |
$152,961,596 |
|
Z430 |
Encounter for attention to tracheostomy |
45,505 |
3,983 |
$148,518,504 |
|
I6930 |
Unspecified sequelae of cerebral infarction |
85,807 |
30,943 |
$148,296,893 |
|
I5033 |
Acute on chronic diastolic (congestive) heart failure |
102,567 |
37,275 |
$141,529,331 |
|
F259 |
Schizoaffective disorder, unspecified |
131,675 |
38,342 |
$139,371,731 |
|
R55 |
Syncope and collapse |
138,025 |
39,959 |
$138,597,417 |
|
S72141D |
Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing |
33,298 |
22,268 |
$135,077,088 |
|
M6259 |
Muscle wasting and atrophy, not elsewhere classified, multiple sites |
206,941 |
34,145 |
$133,261,190 |
|
G809 |
Cerebral palsy, unspecified |
60,466 |
32,009 |
$132,333,857 |
|
I5032 |
Chronic diastolic (congestive) heart failure |
255,902 |
48,210 |
$132,026,393 |
|
I739 |
Peripheral vascular disease, unspecified |
545.275 |
75,756 |
$131,153,761 |
Fig 2. – Data is from the Definitive Healthcare ClaimsMx product for the calendar year 2021. Claims data is sourced from multiple medical claims clearinghouses in the United States and is updated monthly. Data is accurate as of April 2022.
What are the most common skilled nursing facility diagnoses?
Unsurprisingly, COVID-19 tops the list as the most common diagnosis at SNFs both by Medicare and commercial claims data. Long-term care facilities like SNFs were hit particularly hard at the start of the pandemic. As the patient population tends to be elderly, most patients fall into the high-risk category for COVID-19.
Urinary tract infections (UTIs) take second place when looking at Medicare payments and make the top ten by commercial insurance charges. For years, UTIs have been one of the most common long-term care facility infections. If left untreated, UTIs can lead to sepsis, a life threatening condition. Sepsis comes in fourth on the top diagnosis by Medicare payments and the top 15 by commercial claims.
Other common diagnoses at SNFs include respiratory illnesses such as pneumonia and COPD, neurological disorders such as encephalopathy and dementia, and orthopedic conditions.
What is a skilled nursing facility (SNF)?
A skilled nursing facility is an inpatient facility types 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 skill 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.
The biggest difference between a skilled nursing facility and a nursing home is 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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