C — Wound
One of the twelve PDGM clinical groups. CMS maps 4100 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 4100 ICD-10-CM codes to Wound, spread across 28 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 Wound
The same OASIS point total means different things in different groups. In this group a patient scoring 33 or fewer points is low functional impairment, 34 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 |
|---|---|---|
| S30-S39 | Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals | 712 |
| S60-S69 | Injuries to the wrist, hand and fingers | 635 |
| T20-T25 | Burns and corrosions | 482 |
| L80-L99 | Other disorders of the skin and subcutaneous tissue | 335 |
| S20-S29 | Injuries to the thorax | 318 |
| S00-S09 | Injuries to the head | 294 |
| S90-S99 | Injuries to the ankle and foot | 228 |
| S50-S59 | Injuries to the elbow and forearm | 187 |
| S10-S19 | Injuries to the neck | 171 |
| S40-S49 | Injuries to the shoulder and upper arm | 162 |
| L00-L08 | Infections of the skin and subcutaneous tissue | 130 |
| I70-I79 | Diseases of arteries, arterioles and capillaries | 119 |
| S70-S79 | Injuries to the hip and thigh | 102 |
| S80-S89 | Injuries to the knee and lower leg | 90 |
| T80-T88 | Complications of surgical and medical care, not elsewhere classified | 55 |
| I80-I89 | Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified | 38 |
| E08-E13 | Diabetes mellitus | 15 |
| O85-O92 | Complications predominantly related to the puerperium | 10 |
| A30-A49 | Other bacterial diseases | 2 |
| I95-I99 | Other and unspecified disorders of the circulatory system | 2 |
| J30-J39 | Other diseases of upper respiratory tract | 2 |
| L55-L59 | Radiation-related disorders of the skin and subcutaneous tissue | 2 |
| N40-N53 | Diseases of male genital organs | 2 |
| N60-N65 | Disorders of breast | 2 |
| Z40-Z53 | Encounters for other specific health care | 2 |
| A20-A28 | Certain zoonotic bacterial diseases | 1 |
| B85-B89 | Pediculosis, acariasis and other infestations | 1 |
| Q80-Q89 | Other congenital malformations | 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
- BNeuro Rehabilitation
- 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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