J — MMTA - Gastrointestinal tract and Genitourinary system
One of the twelve PDGM clinical groups. CMS maps 915 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 915 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.
Functional impairment thresholds for MMTA - Gastrointestinal tract and Genitourinary system
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 48 is medium, and 49 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 |
|---|---|---|
| K55-K64 | Other diseases of intestines | 134 |
| K20-K31 | Diseases of esophagus, stomach and duodenum | 98 |
| K80-K87 | Disorders of gallbladder, biliary tract and pancreas | 79 |
| K50-K52 | Noninfective enteritis and colitis | 70 |
| N30-N39 | Other diseases of the urinary system | 69 |
| N80-N98 | Noninflammatory disorders of female genital tract | 59 |
| N00-N08 | Glomerular diseases | 50 |
| K70-K77 | Diseases of liver | 49 |
| N40-N53 | Diseases of male genital organs | 49 |
| K90-K95 | Other diseases of the digestive system | 43 |
| K40-K46 | Hernia | 32 |
| N10-N16 | Renal tubulo-interstitial diseases | 30 |
| K00-K14 | Diseases of oral cavity and salivary glands | 26 |
| N99-N99 | Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified | 22 |
| N60-N65 | Disorders of breast | 21 |
| N70-N77 | Inflammatory diseases of female pelvic organs | 20 |
| K35-K38 | Diseases of appendix | 17 |
| K65-K68 | Diseases of peritoneum and retroperitoneum | 16 |
| N25-N29 | Other disorders of kidney and ureter | 12 |
| N17-N19 | Acute kidney failure and chronic kidney disease | 11 |
| N20-N23 | Urolithiasis | 7 |
| L60-L75 | Disorders of skin appendages | 1 |
Source: CMS HH PPS Grouper Software v07.1.26. Counts are read from the CMS table, not transcribed.
The other eleven groups
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