J · MMTA - Gastrointestinal tract and Genitourinary system
One of the twelve PDGM clinical groups. CMS maps 920 ICD-10-CM codes to it in grouper v07.2.26.
Group J
ICD-10-CM codes
920
Across 22 ICD-10-CM ranges, in grouper v07.2.26.
Functional bands
≤34 · 35–48 · 49+
OASIS points for low, medium and high functional impairment in this group.
LUPA thresholds
2 to 4 visits
Across the group’s 36 case-mix codes. Fewer visits than the threshold pays per visit.
Every HIPPS code in group J, with its LUPA threshold
1 · Community, Early
2 · Institutional, Early
3 · Community, Late
ICD-10-CM ranges that feed this group
- K55-K64Other diseases of intestines134
- K20-K31Diseases of esophagus, stomach and duodenum99
- K80-K87Disorders of gallbladder, biliary tract and pancreas79
- K50-K52Noninfective enteritis and colitis70
- N30-N39Other diseases of the urinary system69
- N80-N98Noninflammatory disorders of female genital tract59
- K70-K77Diseases of liver50
- N00-N08Glomerular diseases50
- N40-N53Diseases of male genital organs49
- K90-K95Other diseases of the digestive system43
- K40-K46Hernia32
- N10-N16Renal tubulo-interstitial diseases30
- K00-K14Diseases of oral cavity and salivary glands26
- N99-N99Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified22
- N60-N65Disorders of breast21
- N70-N77Inflammatory diseases of female pelvic organs20
- K65-K6ADiseases of peritoneum and retroperitoneum19
- K35-K38Diseases of appendix17
- N25-N29Other disorders of kidney and ureter12
- N17-N19Acute kidney failure and chronic kidney disease11
- N20-N23Urolithiasis7
- L60-L75Disorders of skin appendages1
What lands a period in this group
The clinical group is set by the principal diagnosis on the claim, and it is one of the five things that decide a 30-day period’s case-mix group, alongside admission source, timing, functional impairment level and comorbidity adjustment. CMS maps 920 ICD-10-CM codes to MMTA - Gastrointestinal tract and Genitourinary system, spread across 22 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.
The other eleven groups
Source: CMS HH PPS Grouper Software v07.2.26 for the codes and bands, read from the CMS table, not transcribed; CMS’s CY2026 case-mix weights and LUPA thresholds file for the thresholds. Not certified, endorsed or approved by CMS.
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