IRF-PAI Coding: Choosing Etiologic Diagnosis for Impairment Group Code of 16, Debility

By Nirmala Sivakumar, CCS, CDIP

Impairment Group Code (IGC) in Inpatient rehab is the primary reason for admission, and etiologic diagnosis is the problem that led to this condition. There are 17 categories of IGC, with subcategories within.

IGC of 16, Debility is generally used for patients that are admitted to inpatient rehab for general deconditioning and debility due to a prolonged hospital stay or a medical condition. In these cases, PPS coordinators tend to use R53.81, Other Malaise as the etiologic diagnosis. This is incorrect. The etiological diagnosis should be the condition that caused the deconditioning or debility. Though the IRF-PAI training manual pairs the code R53.81 with IGC of 16, Debility, it is not appropriate to use it.


A patient was admitted for comprehensive rehabilitation in a very debilitated state after being in an acute facility for two weeks for a recurrent C.diff colitis infection, for which she has completed her course of antibiotics. She has decreased activities of daily living (ADL) and decreased endurance. What is the appropriate IGC and Etiology for the patient?


IGC: 16, Debility

Etiology: A04.71, Enterocolitis due to Clostridium difficile, recurrent (the reason for the debility)

Though the IRF-PAI training manual pairs the code R53.81 with IGC of 16, Debility, it is not appropriate to use it. The etiologic diagnosis should always be the condition that caused the impairment.


Inpatient Rehabilitation Facility: IRF-PAI and UB-04 Coding
Inpatient rehab coding presents a challenge for HIM coders, even those with many years of coding experience. While both the IRF-PAI and UB-04 forms are used by Inpatient Rehabilitation Facilities to report ICD-10-CM codes, there are several key differences. This webinar will help the IRF coder gain a clear understanding of IRF PPS guidelines and how ICD-10-CM coding conventions apply to the IRF setting. Learn more here.


About the author

Nirmala Sivakumar, CCS, CDIP
Nirmala Sivakumar is an IRF Coding Educator based in PA. She has created and presented many webinars and workshops on IRF coding and improving clinical documentation. She has trained and mentored many rehab coders. She also has experience in conducting coding audits. She enjoys sharing her expertise and knowledge and has a desire to help coders and PPS Coordinators overcome the challenges of IRF PPS coding.

She has held previous positions as Health Information Management Supervisor for one of HealthSouth’s (Encompass) acute inpatient rehab hospital and as a HIM Coding Consultant at Uniform Data Systems for Medical Rehabilitation. She can be reached at [email protected] or visit

About the Author

Libman Education
Libman Education Inc. is a leading provider of training for the health care workforce offering self-paced and instructor-led online courses designed and developed by leading industry experts in Health Information Management (HIM) and Medical Record Coding. Our courses are specifically designed to improve individual skills and increase the efficiencies and competencies of health care providers and institutions. At Libman Education, we understand the needs and challenges of a well-trained workforce and offer the right-mix of online education to ensure that the health care professionals are prepared to meet the challenges of the changing workplace.

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