ICD-10 Coding for Failure to Thrive in Adults(R62.7, E46)
Complete ICD-10-CM coding and documentation guide for Failure to Thrive in Adults. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Failure to Thrive in Adults
R62-R64Primary Range
Symptoms and signs involving cognition, perception, emotional state and behavior
This range includes codes for failure to thrive and related conditions such as cachexia and malnutrition.
Malnutrition
This range includes codes for various forms of malnutrition, which may be related to or a consequence of failure to thrive.
Behavioral syndromes associated with physiological disturbances and physical factors
This range includes codes for eating disorders, which can be a contributing factor to failure to thrive.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R62.7 | Adult failure to thrive | Use when no definitive underlying cause is confirmed and multifactorial decline is present. |
|
| E46 | Unspecified protein-energy malnutrition | Use when lab results confirm malnutrition. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: When is R62.7 billable as principal diagnosis?
Essential facts and insights about Failure to Thrive in Adults
Primary ICD-10-CM Codes for failure to thrive adult
Decision Criteria
clinical Criteria
- Presence of unintentional weight loss and functional decline without a specific cause
coding Criteria
- Avoid using as principal diagnosis if a more definitive diagnosis is available
Applicable To
- Multifactorial decline without dominant etiology
Clinical Validation Requirements
- Unintentional weight loss
- BMI < 18.5
- Functional decline
Code-Specific Risks
- Using as principal diagnosis when a more specific condition exists
Coding Notes
- R62.7 should not be used as a principal diagnosis if a more specific treatable condition is identified.
E46 - Unspecified protein-energy malnutrition
Use when lab results confirm malnutrition.
Applicable To
- Protein-calorie malnutrition
Excludes
- Cachexia (R64)
Clinical Validation Requirements
- Albumin < 3.0 g/dL
- BMI < 16.5
Coding Notes
Ensure documentation of lab results supporting malnutrition.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Failure to Thrive in Adults to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R62.7.
Impact
Clinical: Inadequate assessment of patient's nutritional status., Regulatory: Potential non-compliance with coding guidelines., Financial: Possible claim denials or reduced reimbursement.
Mitigation Strategy
Ensure detailed documentation of weight trends, Include lab results supporting malnutrition
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with CMS guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Identify and code the underlying condition as principal diagnosis.
Impact
Using R62.7 as principal diagnosis when a more specific condition is present.
Mitigation Strategy
Thorough review of patient's medical history and test results to identify underlying conditions.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Failure to Thrive in Adults, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Failure to Thrive in Adults
Use these documentation templates to ensure complete and accurate documentation for Failure to Thrive in Adults. These templates include all required elements for proper coding and billing.
Geriatric patient with unexplained weight loss
Specialty: GeriatricsRequired Elements
- Weight trends
- Functional status
- Lab results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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