F — Behavioral Health
One of the twelve PDGM clinical groups. CMS maps 855 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 855 ICD-10-CM codes to Behavioral Health, spread across 14 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 Behavioral Health
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 46 is medium, and 47 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 |
|---|---|---|
| F10-F19 | Mental and behavioral disorders due to psychoactive substance use | 440 |
| F40-F48 | Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders | 68 |
| T66-T78 | Other and unspecified effects of external causes | 63 |
| F30-F39 | Mood [affective] disorders | 62 |
| F50-F59 | Behavioral syndromes associated with physiological disturbances and physical factors | 61 |
| F01-F09 | Mental disorders due to known physiological conditions | 48 |
| F60-F69 | Disorders of adult personality and behavior | 41 |
| F90-F98 | Behavioral and emotional disorders with onset usually occurring in childhood and adolescence | 28 |
| F20-F29 | Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders | 18 |
| F80-F89 | Pervasive and specific developmental disorders | 14 |
| F70-F79 | Intellectual Disabilities | 7 |
| T14-T14 | Injury of unspecified body region | 3 |
| R40-R46 | Symptoms and signs involving cognition, perception, emotional state and behavior | 1 |
| T36-T50 | Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances | 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
- DComplex Nursing Interventions
- EMusculoskeletal Rehabilitation
- 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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