ICD-10 Coding for Frailty(R54, R62.7, M62.84)
Complete ICD-10-CM coding and documentation guide for Frailty. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Frailty
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R54 | Age-related physical debility | Use when frailty is primarily due to aging without specific underlying conditions. |
|
| R62.7 | Adult failure to thrive | Use when frailty is characterized by significant weight loss and functional decline. |
|
| M62.84 | Sarcopenia | Use when muscle loss is a significant component of frailty. |
|
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: ICD-10 code for frailty
Essential facts and insights about Frailty
Primary ICD-10-CM Codes for frailty
Decision Criteria
clinical Criteria
- Age-related decline with functional limitations
documentation Criteria
- Explicit mention of age-related debility
Applicable To
- Senile asthenia
- Senile debility
Clinical Validation Requirements
- Documentation of age-related decline
- Functional assessment indicating debility
Code-Specific Risks
- Misuse for non-age-related weakness
- Lack of specificity in documentation
Coding Notes
- Ensure documentation specifies age-related decline to justify R54.
R62.7 - Adult failure to thrive
Use when frailty is characterized by significant weight loss and functional decline.
Applicable To
- Significant weight loss
- Functional decline
Excludes
- Malnutrition (E46)
Clinical Validation Requirements
- Weight loss ≥5% in 6 months
- Functional decline in ADLs
Coding Notes
Ensure weight loss and functional decline are documented.
M62.84 - Sarcopenia
Use when muscle loss is a significant component of frailty.
Applicable To
- Muscle loss
- Age-related muscle wasting
Excludes
- Cachexia (R64)
Clinical Validation Requirements
- DEXA scan confirmation
- Reduced muscle mass and strength
Coding Notes
Confirm sarcopenia with imaging or biomarkers.
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 Frailty to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R54.
Impact
Clinical: Inaccurate patient assessment, Regulatory: Non-compliance with coding standards, Financial: Potential under-reimbursement
Mitigation Strategy
Use specific terms like 'age-related debility', Document functional assessments
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate representation of patient condition
Mitigation Strategy
Query for 'age-related' or 'senile' terminology
Impact
Reimbursement: Potential under-coding affecting reimbursement, Compliance: Failure to meet coding standards, Data Quality: Incomplete clinical picture
Mitigation Strategy
Add R54/R62.7 as primary code
Impact
Risk of audits due to non-specific documentation of frailty
Mitigation Strategy
Ensure documentation includes age-related terms and functional assessments.
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 Frailty, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Frailty
Use these documentation templates to ensure complete and accurate documentation for Frailty. These templates include all required elements for proper coding and billing.
Geriatric assessment for frailty
Specialty: GeriatricsRequired Elements
- Functional assessment
- ADL dependence
- Weight loss documentation
- Sarcopenia confirmation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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