L — MMTA - Respiratory
One of the twelve PDGM clinical groups. CMS maps 235 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 235 ICD-10-CM codes to MMTA - Respiratory, spread across 12 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 - Respiratory
The same OASIS point total means different things in different groups. In this group a patient scoring 33 or fewer points is low functional impairment, 34 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 |
|---|---|---|
| J09-J18 | Influenza and pneumonia | 47 |
| J40-J4A | Chronic lower respiratory diseases | 39 |
| J60-J70 | Lung diseases due to external agents | 33 |
| J80-J84 | Other respiratory diseases principally affecting the interstitium | 27 |
| J95-J95 | Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified | 26 |
| J96-J99 | Other diseases of the respiratory system | 23 |
| J20-J22 | Other acute lower respiratory infections | 15 |
| J90-J94 | Other diseases of the pleura | 13 |
| J85-J86 | Suppurative and necrotic conditions of the lower respiratory tract | 6 |
| J30-J39 | Other diseases of upper respiratory tract | 3 |
| U00-U49 | Provisional assignment of new diseases of uncertain etiology or emergency use | 2 |
| J00-J06 | Acute upper respiratory infections | 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
- 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
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