Allowable IRF Medical Conditions

The list of medical conditions is shown in the table below:

  Medical Condition Additional comments relating to the Medical Condition
1. Stroke  
2. Spinal Cord Injury  
3. Congenital Deformity  
4. Amputation  
5. Major Multiple Trauma  
6. Femur Fracture  
7. Brain Injury  
8. Neurological Disorders Includes Multiple Sclerosis, motor neuron disease, polyneuropathy, muscular dystrophy and Parkinsons
9. Burns  
10. Active polyarticular rheumatoid arthritis, psoriatic arthritis and seronegative arthropathies. The noted conditions must result in significant functional impairment of ambulation and other activities of daily living that:
  • Have not improved after an appropriate, aggressive and sustained course of outpatient therapy services or services in other less intensive rehabilitation settings immediately preceding the inpatient rehabilitation admission; or
  • Result from a systemic disease activation immediately before admission, but have the potential to improve with more intensive rehabilitation.
The related CR 3334 provides guidance regarding therapy. However, the medical review staff of the FI has the discretion to define:
  • What is an appropriate, aggressive and sisteined course of outpatient therapy services or services in other less intensive rehabilitation settings immediately preceding the inpatient rehabilitation admission; and
  • When a systemic disease activation immediately before admission has occurred.
11. Systemic vasculidities with joint inflammation The noted condition must result in significant functional impairment of ambulation and other activities of daily living that:
  • Have not improved after an appropriate, aggressive and sustained course of outpatient therapy services or services in other less intensive rehabilitation settings immediately preceding the inpatient rehabilitation admission; or
  • Result from a systemic disease activation immediately before admission, but have the potential to improve with more intensive rehabilitation.
The related CR 3334 provides guidance regarding therapy. However, the medical review staff of the FI has the discretion to define:
  • What is an appropriate, aggressive and sisteined course of outpatient therapy services or services in other less intensive rehabilitation settings immediately preceding the inpatient rehabilitation admission; and
  • When a systemic disease activation immediately before admission has occurred.
12. Severe or advanced osteoarthritis (osteoarthritis or degenerative joint disease) involving two or more major weight bears joints (elbow, shoulders, hips or knees, but not counting a joint with prosthesis) with joint deformity and substantial loss of range of motion, atrophy of muscles surrounding the joint. The noted condition must result in significant functional impairment of ambulation and other activities of daily living that:
  • Have not improved after an appropriate, aggressive and sustained course of outpatient therapy services or services in other less intensive rehabilitation settings immediately preceding the inpatient rehabilitation admission; or
  • Result from systemic disease activation immediately before admission, but have the potential to improve with more intensive rehabilitation.
The related CR 3334 provides guidance regarding therapy. However, the medical review staff of the FI has the discretion to define:
  • What is an appropriate, aggressive and sustained course of outpatient therapy services or services in other less intensive rehabilitation settings immediately preceding the inpatient rehabilitation admission; and
  • When a systemic disease activation immediately before admission has occurred.
Please note, a joint replaced by prosthesis is no longer considered to have osteoarthritis, or other arthritis, even though this condition was the reason for the joint replacement.
13. Knee or hip joint replacement or both, during an acute hospitalization immediately preceding the inpatient rehabilitation stay. This condition must also meet one or more of the following specific criteria; the patient:
  • Underwent bilateral knee or bilateral hip replacement surgery during the acute hospital admission immediately preceding the IRF admission;
  • Is extremely obese with a Body Mass Index of at least 50 at the time of admission to the IRF;
  • Is age 85 or older at the time of admission to the IRF

Page Last Updated: Thursday, 15-Dec-2011 14:39:33 CST