K — MMTA - Infectious Disease, Neoplasms, and Blood-Forming Diseases
One of the twelve PDGM clinical groups. CMS maps 2742 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 2742 ICD-10-CM codes to MMTA - Infectious Disease, Neoplasms, and Blood-Forming Diseases, spread across 51 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 - Infectious Disease, Neoplasms, and Blood-Forming Diseases
The same OASIS point total means different things in different groups. In this group a patient scoring 32 or fewer points is low functional impairment, 33 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 |
|---|---|---|
| C81-C96 | Malignant neoplasms of lymphoid, hematopoietic and related tissue | 533 |
| D10-D36 | Benign neoplasms, except benign neuroendocrine tumors | 186 |
| A50-A64 | Infections with a predominantly sexual mode of transmission | 121 |
| T80-T88 | Complications of surgical and medical care, not elsewhere classified | 120 |
| C43-C44 | Melanoma and other malignant neoplasms of skin | 112 |
| A30-A49 | Other bacterial diseases | 100 |
| B35-B49 | Mycoses | 100 |
| D37-D48 | Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes | 93 |
| B65-B83 | Helminthiases | 82 |
| D00-D09 | In situ neoplasms | 80 |
| A00-A09 | Intestinal infectious diseases | 76 |
| D55-D59 | Hemolytic anemias | 72 |
| D80-D89 | Certain disorders involving the immune mechanism | 70 |
| B00-B09 | Viral infections characterized by skin and mucous membrane lesions | 66 |
| C15-C26 | Malignant neoplasms of digestive organs | 60 |
| C00-C14 | Malignant neoplasms | 59 |
| D70-D77 | Other disorders of blood and blood-forming organs | 56 |
| B50-B64 | Protozoal diseases | 52 |
| A20-A28 | Certain zoonotic bacterial diseases | 44 |
| C45-C49 | Malignant neoplasms of mesothelial and soft tissue | 43 |
| C76-C80 | Malignant neoplasms of ill-defined, other secondary and unspecified sites | 43 |
| B25-B34 | Other viral diseases | 42 |
| A15-A19 | Tuberculosis | 39 |
| D65-D69 | Coagulation defects, purpura and other hemorrhagic conditions | 39 |
| C50-C50 | Malignant neoplasms of breast | 38 |
| C30-C39 | Malignant neoplasms of respiratory and intrathoracic organs | 34 |
| A90-A99 | Arthropod-borne viral fevers and viral hemorrhagic fevers | 32 |
| C51-C58 | Malignant neoplasms of female genital organs | 31 |
| A65-A69 | Other spirochetal diseases | 27 |
| D60-D64 | Aplastic and other anemias and other bone marrow failure syndromes | 25 |
| B15-B19 | Viral hepatitis | 23 |
| C7A-C7A | Malignant neuroendocrine tumors | 22 |
| A75-A79 | Rickettsioses | 21 |
| D3A-D3A | Benign neuroendocrine tumors | 21 |
| B85-B89 | Pediculosis, acariasis and other infestations | 20 |
| C60-C63 | Malignant neoplasms of male genital organs | 19 |
| C64-C68 | Malignant neoplasms of urinary tract | 19 |
| C69-C72 | Malignant neoplasms of eye, brain and other parts of central nervous system | 19 |
| D50-D53 | Nutritional anemias | 19 |
| C40-C41 | Malignant neoplasms of bone and articular cartilage | 18 |
| C73-C75 | Malignant neoplasms of thyroid and other endocrine glands | 16 |
| D78-D78 | Intraoperative and postprocedural complications of the spleen | 12 |
| D49-D49 | Neoplasms of unspecified behavior | 10 |
| A70-A74 | Other diseases caused by chlamydiae | 8 |
| C7B-C7B | Secondary neuroendocrine tumors | 7 |
| A80-A89 | Viral and prion infections of the central nervous system | 6 |
| B10-B10 | Other human herpesviruses | 3 |
| B20-B20 | Human immunodeficiency virus [HIV] disease | 1 |
| E70-E88 | Metabolic disorders | 1 |
| O85-O92 | Complications predominantly related to the puerperium | 1 |
| Z20-Z29 | Persons with potential health hazards related to communicable diseases | 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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