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:

• Amputation
• Brain injury
• Burns
• Spinal Cord Injury
• Stroke
• Congenital deformity
• Hip fracture
• Joint Replacements
• Major multiple trauma
  • Multiple fracture
• Neurological disorders 
  • Multiple sclerosis
  • Motor neuron disease
  • Encephalopathy
  • Critical illness myopathy/polyneuropathy
  • ALS
  • Parkinson’s disease
  • Guillain Barré
• Systemic vasculidities with joint inflammation
• Active rheumatoid arthritis, Psoriatic Arthritis, Seronegative Arthropathies
• Severe or Advanced Osteoarthritis

Other rehabilitation diagnoses and conditions doctors and case managers should consider for rehabilitation may include diagnoses such as:

• Immune Deficiency Diseases
• Abdominal aortic aneurysm
• Cardiac conditions such as
  • Coronary artery bypass graft (CABG) 
  • Congestive heart failure (CHF)
  • Myocardial infarction (MI)
• Laminectomy
• Neuropathy
• Orthopedic injuries
• Pneumonia
• 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 

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