Skilled nursing facilities (SNFs) are a critical part of the healthcare system, especially as the population ages and the need for comprehensive Long-term Care Diagnosis becomes increasingly important. These facilities bridge the gap between hospital care and home recovery, providing essential services for elderly patients and others requiring specialized medical attention. Definitive Healthcare tracks data on over 20,000 skilled nursing facilities, offering valuable insights into this sector of healthcare.
Given that SNFs frequently cater to elderly patients and Medicare beneficiaries who often require long-term care diagnosis and management, an examination of the most common diagnoses within these facilities is crucial. Analyzing both Medicare and commercial claims data reveals the prevalent health conditions requiring skilled nursing care.
Top 50 ICD-10 Codes in Skilled Nursing Facilities: A Claims-Based Overview
The following table presents the 50 most frequent ICD-10 codes observed in skilled nursing facilities, based on the percentage of claims. This data offers a snapshot of the primary health concerns addressed in these long-term care diagnosis settings.
| Rank | ICD-10 code | ICD-10 description | % of claims | Explore dataset |
|---|---|---|---|---|
| 1 | U071 | COVID-19 | 9.33% | Explore |
| 2 | G9341 | Metabolic encephalopathy | 3.30% | Explore |
| 3 | N390 | Urinary tract infection, site not specified | 2.92% | Explore |
| 4 | Z471 | Aftercare following joint replacement surgery | 1.81% | Explore |
| 5 | A419 | Sepsis, unspecified organism | 1.74% | Explore |
| 6 | J189 | Pneumonia, unspecified organism | 1.73% | Explore |
| 7 | G20 | Parkinson’s disease | 1.64% | Explore |
| 8 | Z4789 | Encounter for other orthopedic aftercare | 1.63% | Explore |
| 9 | G9340 | Encephalopathy, unspecified | 1.60% | Explore |
| 10 | J449 | Chronic obstructive pulmonary disease, unspecified | 1.54% | Explore |
| 11 | J9601 | Acute respiratory failure with hypoxia | 1.53% | Explore |
| 12 | I639 | Cerebral infarction, unspecified | 1.49% | Explore |
| 13 | F0390 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | 1.07% | Explore |
| 14 | M6259 | Muscle wasting and atrophy, not elsewhere classified, multiple sites | 0.95% | Explore |
| 15 | I69354 | Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side | 0.92% | Explore |
| 16 | J441 | Chronic obstructive pulmonary disease with (acute) exacerbation | 0.91% | Explore |
| 17 | N179 | Acute kidney failure, unspecified | 0.87% | Explore |
| 18 | S72002D | Fracture of unspecified part of neck of left femur, subsequent encounter for closed fracture with routine healing | 0.84% | Explore |
| 19 | S72001D | Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing | 0.84% | Explore |
| 20 | I69351 | Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side | 0.83% | Explore |
| 21 | Z48815 | Encounter for surgical aftercare following surgery on the digestive system | 0.82% | Explore |
| 22 | Z4781 | Encounter for orthopedic aftercare following surgical amputation | 0.77% | Explore |
| 23 | S72142D | Displaced intertrochanteric fracture of left femur, subsequent encounter for closed fracture with routine healing | 0.76% | Explore |
| 24 | I509 | Heart failure, unspecified | 0.74% | Explore |
| 25 | R278 | Other lack of coordination | 0.73% | Explore |
| 26 | S72141D | Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing | 0.71% | Explore |
| 27 | I4891 | Unspecified atrial fibrillation | 0.68% | Explore |
| 28 | I5033 | Acute on chronic diastolic (congestive) heart failure | 0.59% | Explore |
| 29 | J9621 | Acute and chronic respiratory failure with hypoxia | 0.59% | Explore |
| 30 | M6282 | Rhabdomyolysis | 0.58% | Explore |
| 31 | G309 | Alzheimer’s disease, unspecified | 0.56% | Explore |
| 32 | N186 | End stage renal disease | 0.54% | Explore |
| 33 | Z48812 | Encounter for surgical aftercare following surgery on the circulatory system | 0.53% | Explore |
| 34 | I214 | Non-ST elevation (NSTEMI) myocardial infarction | 0.52% | Explore |
| 35 | F0391 | Unspecified dementia, unspecified severity, with behavioral disturbance | 0.51% | Explore |
| 36 | E119 | Type 2 diabetes mellitus without complications | 0.47% | Explore |
| 37 | L03115 | Cellulitis of right lower limb | 0.46% | Explore |
| 38 | R55 | Syncope and collapse | 0.46% | Explore |
| 39 | L03116 | Cellulitis of left lower limb | 0.45% | Explore |
| 40 | I6930 | Unspecified sequelae of cerebral infarction | 0.42% | Explore |
| 41 | G35 | Multiple sclerosis | 0.42% | Explore |
| 42 | I2510 | Atherosclerotic heart disease of native coronary artery without angina pectoris | 0.40% | Explore |
| 43 | I5023 | Acute on chronic systolic (congestive) heart failure | 0.38% | Explore |
| 44 | I480 | Paroxysmal atrial fibrillation | 0.37% | Explore |
| 45 | J690 | Pneumonitis due to inhalation of food and vomit | 0.36% | Explore |
| 46 | D649 | Anemia, unspecified | 0.36% | Explore |
| 47 | I69398 | Other sequelae of cerebral infarction | 0.31% | Explore |
| 48 | S065X0D | Traumatic subdural hemorrhage without loss of consciousness, subsequent encounter | 0.31% | Explore |
| 49 | S7291XD | Unspecified fracture of right femur, subsequent encounter for closed fracture with routine healing | 0.30% | Explore |
| 50 | E871 | Hypo-osmolality and hyponatremia | 0.29% | Explore |
Understanding Common Diagnoses in Long-Term Care Settings
As evident from the data, the most prevalent diagnosis in skilled nursing facilities is COVID-19, accounting for 9.33% of all SNF diagnosis claims. Long-term care facilities, particularly SNFs, experienced significant challenges during the pandemic. The vulnerability of the elderly patient population, who are at higher risk for severe COVID-19 outcomes, contributed to this high percentage. This underscores the importance of robust infection control and long-term care diagnosis strategies within these facilities.
Metabolic encephalopathy ranks second, representing 3.30% of SNF claims. This condition, a neurological disorder resulting from systemic illnesses like heart disease, diabetes, and kidney or respiratory failure, highlights the complexity of long-term care diagnosis in SNFs. Patients with these chronic conditions often require the specialized and continuous care provided in these settings.
Urinary tract infections (UTIs) are the third most common diagnosis, with 2.92% of claims. UTIs are a significant concern in nursing homes and are among the most common healthcare-acquired conditions. Effective long-term care diagnosis protocols and preventative measures are essential to manage and reduce the incidence of UTIs in SNFs.
Other frequent diagnoses in SNFs include respiratory conditions such as pneumonia and COPD, neurological disorders like dementia, and various orthopedic issues. This diverse range of diagnoses emphasizes the multifaceted nature of healthcare provided in skilled nursing environments and the breadth of long-term care diagnosis expertise needed.
What Defines a Skilled Nursing Facility in Long-Term Care?
A skilled nursing facility is an inpatient facility designed to offer both short-term and long-term rehabilitation services within the spectrum of long-term care diagnosis. These facilities are equipped to provide 24-hour licensed medical support to patients needing transitional care. This care typically follows a hospital stay due to illness, injury, or surgery, making SNFs a crucial step in patient recovery.
Primarily serving elderly patients, the majority of SNFs are Medicare-certified. Medicare coverage extends up to 100 days in an SNF, with patients incurring out-of-pocket expenses for each day beyond this limit. Understanding Medicare guidelines is essential for both patients and healthcare providers involved in long-term care diagnosis and planning.
Qualifying for Skilled Nursing Care: Medicare Guidelines
For patients to qualify for skilled nursing care covered by Medicare, several criteria must be met. These guidelines ensure that Medicare benefits are appropriately utilized for individuals requiring genuine skilled nursing or rehabilitative therapy as part of their long-term care diagnosis plan.
Under Medicare, coverage for SNF care is provided if:
- The beneficiary is enrolled in Medicare Part A and has benefit period days available.
- The patient was formally admitted to inpatient care in a hospital for at least three consecutive days.
- Entry into a Medicare-certified SNF occurs within 30 days of hospital discharge, related to the same condition treated during the hospital stay.
- A physician certifies the need for daily skilled care, delivered by or supervised by skilled nursing or therapy staff.
Patients in SNFs can access a range of skilled nursing services, integral to their long-term care diagnosis and management, including:
- Medication management and administration
- Assistance with activities of daily living
- Dietary services and meal preparation
- Specialized wound care management
- Physical, occupational, and speech therapy
- Cardiac rehabilitation programs
- Post-stroke rehabilitation and recovery support
SNF, Assisted Living, and Nursing Homes: Key Distinctions in Long-Term Care
It’s important to differentiate skilled nursing facilities from other types of long-term care diagnosis settings like assisted living facilities and nursing homes. Assisted living facilities primarily offer personal care in a residential, community-based setting, suitable for individuals needing some clinical support but less intensive medical care than provided in SNFs. In contrast, SNFs are focused on medical and rehabilitative care.
Nursing homes, unlike SNFs which are typically for short-term rehabilitation or recovery, often serve as permanent residences for individuals needing continuous 24/7 care. SNFs are designed for temporary stays focused on rehabilitation or skilled nursing, usually following hospitalization, with a defined duration of care as part of a broader long-term care diagnosis strategy.
Further Insights into Long-Term Care Diagnosis
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