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
• Physical medicine and rehabilitation 
• 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

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