Adult Failure to Thrive (Debility Not Otherwise Specified)
This condition is most commonly seen in the frail elderly who may not have one specific terminal illness, but may have one or more chronic illness. In the absence of a known terminal illness, these patients often have poor appetite, loss of weight, increased fatigue and a progressive functional decline. Such frail elders may be eligible for the services provided by the Medicare Hospice Benefit under the diagnosis of “failure to thrive” or debility NOS.
The ICD-9-CM Codes for Adult Failure to Thrive for billing purposes are as follows: 783.4 Failure to Thrive 799.3 Debility Unspecified 799.9.Other unknown and unspecified causes of morbidity and mortality.
Consider this diagnosis if the frail elderly patient has:
- Unexplained weight loss resulting in a Body Mass Index (BMI) of 22 kg/m2 or less, and
- Karnofsky Performance Status of 40% or less.
In this situation patients may have several medical conditions, such as moderate dementia and congestive heart failure with chronic renal insufficiency. While they may not qualify for hospice under any one of the specific conditions, the patient’s overall health is so compromised that prognosis is limited. This is usually documented by poor functional status as illustrated by ADLs (activities of daily living). It is important that there is a temporal decline in functional status as opposed in contrast to a patient with low level of functional status but who is stable at that level for the foreseeable future