How to Refer a Patient

What physicians and case managers should know

Physicians and case managers may not be aware that Medicare requires that only 60% of acute patients have a CMS-13 diagnosis, which are:

Active polyarticular rheumatoid arthritis
Amputation
Brain injury/brain tumor
Burns
Congenital deformity
Hip fracture
Hip/knee replacement
BMI>50
Bilateral joins (both sides at same time)
85 years or older
Major multiple trauma
Multiple fracture
Neurological disorders (not an all-inclusive list)
Multiple sclerosis
Motor neuron disease
Encephalopathy
Critical illness myopathy/polyneuropathy
Guillain Barré
ALS
Parkinson’s disease
Late effects polio
Friedreich’s ataxia
Osteoarthritis or degenerative joint disease
Two or more weight-bearing joints
Spinal cord impairment
Stroke
Systemic vasculidities with joint inflammation

40% of the other rehabilitation diagnoses and conditions doctors and case managers should consider for rehabilitation:

Temporal arteritis
Polymyalgia
PMR
Lupus
Rheumatica
Gouty arthritis
Abdominal aortic aneurysm
Coronary artery bypass graft (CABG)
Cancer
Cardiac conditions
Congestive heart failure (CHF)
Debility
Joint replacement
Laminectomy
Myocardial infarction (MI)
Neuropathy
Orthopedic injuries
Pneumonia
Peripheral vascular disease (PVD)
Respiratory failure
Wound care
Conditions affecting mobility, activities of daily living (ADL’s), swallowing or cognition/thinking abilities
Late effects from previous neurological injury or illness, i.e. brain injury, stroke or spinal cord injury
Other conditions or complications
Supporting doctor, nursing and therapy documentation
Patient’s level of independence before illness or injury

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