Cardiovascular
I10
Essential (primary) hypertension
I50.9
Heart failure, unspecified
I48.91
Atrial fibrillation
I25.10
Atherosclerotic heart disease
I70.25
Atherosclerosis of native arteries of extremities
Endocrine/Metabolic
E11.9
Type 2 diabetes mellitus without complications
E11.65
Type 2 diabetes with hyperglycemia
E11.51
Type 2 diabetes with diabetic peripheral angiopathy
E78.5
Hyperlipidemia, unspecified
E66.9
Obesity, unspecified (BMI ≥40)
E03.9
Hypothyroidism, unspecified
Renal
N18.3
Chronic kidney disease, stage 3
N18.4
Chronic kidney disease, stage 4
N18.5
Chronic kidney disease, stage 5
N31.9
Neuromuscular dysfunction of bladder, unspecified
Respiratory
J44.1
COPD with acute exacerbation
J44.0
COPD with acute lower respiratory infection
J96.01
Acute respiratory failure with hypoxia
J45.909
Asthma, unspecified
Z99.11
Dependence on respirator [ventilator]
Gastrointestinal
K21.9
Gastro-esophageal reflux disease
K59.00
Constipation, unspecified
K59.2
Neurogenic bowel
R63.3
Feeding difficulties
Hematologic
D64.9
Anemia, unspecified
D50.9
Iron deficiency anemia
Z79.01
Long term use of anticoagulants
Neurological
G40.909
Epilepsy, unspecified
F07.81
Postconcussional syndrome
Psychiatric
F32.9
Major depressive disorder, single episode
F41.9
Anxiety disorder, unspecified
F03.90
Unspecified dementia without behavioral disturbance
Musculoskeletal
M81.0
Age-related osteoporosis without current pathological fracture
M62.50
Muscle wasting and atrophy
M79.3
Panniculitis, unspecified
Infectious
J18.9
Pneumonia, unspecified organism
N39.0
Urinary tract infection, site not specified
L03.90
Cellulitis, unspecified
Other
R53.83
Other fatigue
R26.89
Other abnormalities of gait and mobility
R47.01
Aphasia
R13.10
Dysphagia, unspecified
T1
Tier 1
0
No comorbidities selected
Tier 1
0 comorbidities
Tier 2
1-2 comorbidities
Tier 3
3+ comorbidities
✓ DO Count These:
- • Active conditions requiring treatment during IRF stay
- • Conditions requiring ongoing monitoring or medication
- • Conditions that affect rehabilitation progress
- • Conditions that require nursing or physician management
- • Comorbidities documented in physician H&P or progress notes
✗ DO NOT Count These:
- • History codes (Z-codes) unless actively managed
- • Resolved conditions from acute care stay
- • Conditions not documented in IRF medical record
- • Symptoms that are part of the primary diagnosis
- • Conditions that don't require treatment or monitoring
Verification Checklist:
- ☐ Is the comorbidity documented in the physician H&P or progress notes?
- ☐ Is the comorbidity actively treated with medications or interventions?
- ☐ Does the comorbidity require ongoing monitoring during the IRF stay?
- ☐ Is the comorbidity distinct from the primary diagnosis?
If you answer "YES" to all four questions, the comorbidity should be counted toward tier assignment.