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1.
STROKE: All diagnosis strokes, cerebrovascular
accident, cerebral thrombosis or any late effects of the above
conditions. Approximate onset date is helpful.
2. SPINAL CORD INJURY: Paralysis, quadriplegia,
paraplegia, CNS damage or any other residuals due to an injury
or spinal trauma including renal complications and/or includes
DDD with myelopathy. Excluding stenosis or injury to nerve
root.
3.
CONGENTIAL DEFORMITY: Any physical deformity
or residual at birth.
4. AMPUTATION: Amputations unilateral or bilateral
of lower or upper extremity. Excluding toes or fingers.
5. MAJOR MULTIPLE TRAUMAS: Trauma effecting
more than on body system.
6. HIP FRACTURE: Any type fractures effecting
the neck of femur.
7. BRAIN INJURY: Residual or late effect of
open or closed head injury.
8. NEUROLOGICAL DISORDERS: Multiple sclerosis,
motor neuron disease, muscular dystrophy and Parkinson's disease
exacerbation. Poly-neuropathy (excluding diabetic neuropathy).
Please state reason for neuropathy. Does not include Alzheimer's.
9. BURNS: New burn wounds or residual (I.E.
contractures, scars, blisters, etc).
10. ACTIVE POLYARTICULAR RHEUMATOID ARTHRITIS:
Significant impairment that is unimproved after 3 weeks of
aggressive therapy in less intestive setting immediately proceeding
admits. (Outpatient therapy notes must be obtained and placed
in record).
11. SYSTEMIC VASCULIDITIES: Joint inflammation
such as certain lupus conditions (polymyositis) with same
therapy requirements as above.
12. SEVERE OR ADVANCED OSTEOARTHRITIS: Significant
impairment that is unimproved after 3 weeks of aggressive
therapy in less intensive setting immediately proceeding admits.
(Subject to change per Fiscal Intermediary decision if audited).
13. KNEE OR HIP REPLACEMENT: Joint replacement
during an acute hospitalization immediately preceeding the
IRF admission and also meeting one or more of the following:
a) Bilateral knee or bilateral hip Replacement.
b) Morbidly obese with BMI of at least 50 at time of IRF admission
and stated by physicial in our record.
c) Age 85 or older at the time of admission to IRF.
BMI FORMULA = Weight divided by height divided by height x
703
(i.e) 63", weight 285 = 50.47 body mass.
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