Quick Reference for R62.7
| Code | Description | Billable | Age Range | Effective Date |
|---|---|---|---|---|
| R62.7 | Adult Failure to Thrive | Yes | 15-124 years | October 1, 2024 – September 30, 2025 (ICD-10-CM 2025) |
Understanding Adult Failure to Thrive (AFT)
Defining AFT
Adult Failure to Thrive (AFT) is a complex syndrome characterized by unintentional weight loss, decreased appetite, poor nutrition, and physical and cognitive decline. It often involves psychosocial factors and reduced ability to perform activities of daily living (ADLs). AFT represents a progressive decline affecting an individual’s overall well-being and quality of life. Current research suggests inflammation and social isolation may contribute to AFT, though further study is needed.
When to Use R62.7
Code R62.7 is appropriate for patients aged 15-124 exhibiting the defining characteristics of AFT when a more specific diagnosis is not yet established or when AFT itself is the primary concern. This code is often utilized in conjunction with MS-DRGs 640 and 641 for billing purposes. It’s important to remember that AFT can manifest differently based on age and underlying health conditions, so individualized assessment is key.
Crucial: Comprehensive Documentation is Required
Simply noting “frail” or “weak” is insufficient. Strong supporting documentation is paramount for accurate coding and successful claims. Provide specific, measurable details:
- Quantifiable Weight Loss: “15-pound weight loss over 3 months,” not just “weight loss.”
- Appetite Changes: “Patient reports eating only one meal per day,” not just “poor appetite.”
- Functional Decline: “Patient requires assistance with bathing,” not just “difficulty with ADLs.”
- Objective Measures: Include BMI, lab results (e.g., low albumin), and cognitive assessments.
When Not to Use R62.7
- Pediatric Patients (Under 15): Use R62.51 (Failure to Thrive, Child).
- Dehydration (Primary): Use E86.0. R62.7 might be a secondary diagnosis if AFT is also present.
- Underlying Condition: Code the underlying disease first (e.g., cancer, dementia) and consider R62.7 as a secondary code if the clinical picture warrants it. For example, if a patient has a wasting disease due to cancer, the cancer code (C00-C97) would be primary, and R62.7 could be secondary. Similarly, if a patient has wasting disease due to AIDS, the AIDS codes (B20-B24) would take precedence.
- Specific Nutritional Deficiency: Code the deficiency from category E63 first.
Related Codes
- R62 (Other Lack of Expected Normal Physiological Development): This broader category provides context for R62.7.
- E63 (Nutritional Deficiencies): Use these codes if specific deficiencies contribute to AFT.
- E88.A (Other Metabolic Abnormalities): Consider these if metabolic factors play a role.
Documentation Examples
- Strong Documentation: “75-year-old female with 15-pound weight loss over the past 3 months reports decreased appetite and difficulty with meal preparation due to recent hip fracture. BMI now 17. Lab results show low albumin and vitamin D deficiency (E55.9). Patient also exhibits difficulty with bathing and dressing.”
- Weak Documentation: “Patient looks frail and has lost weight.”
Frequently Asked Questions
- What are common comorbidities? Dementia, depression, chronic heart failure, chronic kidney disease, and other chronic illnesses are often associated with AFT.
- What if the decline is sudden? R62.7 likely isn’t appropriate for acute decline. Investigate for an acute cause.
- Are there genetic or environmental factors involved in AFT? Research is ongoing; some studies suggest possible links.
Source and Updates
ICD-10-CM Official Guidelines for Coding and Reporting FY 2025 (Effective October 1, 2024 – September 30, 2025)
Disclaimer: This information is for educational purposes only and does not constitute medical advice. Consult official coding guidelines and medical professionals for diagnostic and coding decisions.
