B — Neuro Rehabilitation
One of the twelve PDGM clinical groups. CMS maps 2115 ICD-10-CM codes to it in grouper v07.1.26.
What lands a period in this group
The clinical group is set by the diagnosis reported in the primary position, and it is one of the five things that decide a 30-day period’s payment group — alongside admission source, timing, functional impairment level and comorbidity adjustment. CMS maps 2115 ICD-10-CM codes to Neuro Rehabilitation, spread across 54 ICD-10-CM ranges.
Those ranges are not always the ones you would expect from the chapter. Cerebrovascular disease sits in the circulatory chapter alongside heart failure, but CMS groups strokes as neurological rehabilitation — which is why the chapter a code lives in is a poor guide to how it pays.
Functional impairment thresholds for Neuro Rehabilitation
The same OASIS point total means different things in different groups. In this group a patient scoring 34 or fewer points is low functional impairment, 35 to 52 is medium, and 53 or more is high. CMS sets the bands so roughly a third of periods in each group land in each level, which is why the same documentation can produce a different level in a different group.
ICD-10-CM ranges that feed this group
| Range | Description | Codes in this group |
|---|---|---|
| S00-S09 | Injuries to the head | 564 |
| I60-I69 | Cerebrovascular diseases | 370 |
| S10-S19 | Injuries to the neck | 138 |
| T80-T88 | Complications of surgical and medical care, not elsewhere classified | 114 |
| G50-G59 | Nerve, nerve root and plexus disorders | 80 |
| S60-S69 | Injuries to the wrist, hand and fingers | 75 |
| G89-G99 | Other disorders of the nervous system | 73 |
| S20-S29 | Injuries to the thorax | 63 |
| S30-S39 | Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals | 62 |
| G80-G83 | Cerebral palsy and other paralytic syndromes | 47 |
| A80-A89 | Viral and prion infections of the central nervous system | 42 |
| S40-S49 | Injuries to the shoulder and upper arm | 42 |
| G70-G73 | Diseases of myoneural junction and muscle | 40 |
| S90-S99 | Injuries to the ankle and foot | 30 |
| G20-G26 | Extrapyramidal and movement disorders | 27 |
| G00-G09 | Inflammatory diseases of the central nervous system | 26 |
| G10-G14 | Systemic atrophies primarily affecting the central nervous system | 24 |
| S70-S79 | Injuries to the hip and thigh | 24 |
| S80-S89 | Injuries to the knee and lower leg | 24 |
| C69-C72 | Malignant neoplasms of eye, brain and other parts of central nervous system | 22 |
| G35-G37 | Demyelinating diseases of the central nervous system | 21 |
| G60-G65 | Polyneuropathies and other disorders of the peripheral nervous system | 20 |
| A50-A64 | Infections with a predominantly sexual mode of transmission | 18 |
| G30-G32 | Other degenerative diseases of the nervous system | 17 |
| Q00-Q07 | Congenital malformations of the nervous system | 15 |
| B00-B09 | Viral infections characterized by skin and mucous membrane lesions | 14 |
| QA0-QA0 | Genetic disorders, not elsewhere classified | 13 |
| B25-B34 | Other viral diseases | 11 |
| P10-P15 | Birth trauma | 10 |
| G40-G47 | Episodic and paroxysmal disorders | 8 |
| P50-P61 | Hemorrhagic and hematological disorders of newborn | 8 |
| A15-A19 | Tuberculosis | 7 |
| A30-A49 | Other bacterial diseases | 6 |
| D10-D36 | Benign neoplasms, except benign neuroendocrine tumors | 6 |
| D55-D59 | Hemolytic anemias | 6 |
| Q80-Q89 | Other congenital malformations | 6 |
| R10-R19 | Symptoms and signs involving the digestive system and abdomen | 6 |
| D37-D48 | Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes | 5 |
| B35-B49 | Mycoses | 4 |
| B50-B64 | Protozoal diseases | 4 |
| P90-P96 | Other disorders originating in the perinatal period | 4 |
| A00-A09 | Intestinal infectious diseases | 2 |
| A90-A99 | Arthropod-borne viral fevers and viral hemorrhagic fevers | 2 |
| B10-B10 | Other human herpesviruses | 2 |
| C76-C80 | Malignant neoplasms of ill-defined, other secondary and unspecified sites | 2 |
| D49-D49 | Neoplasms of unspecified behavior | 2 |
| E08-E13 | Diabetes mellitus | 2 |
| A20-A28 | Certain zoonotic bacterial diseases | 1 |
| A65-A69 | Other spirochetal diseases | 1 |
| B65-B83 | Helminthiases | 1 |
| D80-D89 | Certain disorders involving the immune mechanism | 1 |
| E70-E88 | Metabolic disorders | 1 |
| K70-K77 | Diseases of liver | 1 |
| Q65-Q79 | Congenital malformations and deformations of the musculoskeletal system | 1 |
Source: CMS HH PPS Grouper Software v07.1.26. Counts are read from the CMS table, not transcribed.
The other eleven groups
- AMMTA - Other
- CWound
- DComplex Nursing Interventions
- EMusculoskeletal Rehabilitation
- FBehavioral Health
- GMMTA - Surgical Aftercare
- HMMTA - Cardiac and Circulatory
- IMMTA - Endocrine
- JMMTA - Gastrointestinal tract and Genitourinary system
- KMMTA - Infectious Disease, Neoplasms, and Blood-Forming Diseases
- LMMTA - Respiratory
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