D — Complex Nursing Interventions
One of the twelve PDGM clinical groups. CMS maps 90 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 90 ICD-10-CM codes to Complex Nursing Interventions, spread across 6 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 Complex Nursing Interventions
The same OASIS point total means different things in different groups. In this group a patient scoring 31 or fewer points is low functional impairment, 32 to 54 is medium, and 55 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 |
|---|---|---|
| T80-T88 | Complications of surgical and medical care, not elsewhere classified | 39 |
| K90-K95 | Other diseases of the digestive system | 16 |
| N99-N99 | Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified | 16 |
| Z40-Z53 | Encounters for other specific health care | 13 |
| J95-J95 | Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified | 5 |
| Z77-Z99 | Persons with potential health hazards related to family and personal history and certain conditions influencing health status | 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
- CWound
- 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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