We Care Hospice

Adult Failure To Thrive / Debility, Unspecified 

Medicare considers Debility, unspecified an appropriate diagnosis for hospice patients when a current weight is unobtainable to obtain a body mass index.  When body mass index is not met, Debility, unspecified may be used for patients who meet the general hospice criteria.

The patient muct meet the criteria in number's 1 and 2 to use the "Adult Failure to Thrive" ICD-9 code 783.7 and to be considered appropriate for admission to hospice.  An admission weight muct be obtained to use Adult Failure to Thrive on admission.  Measurements/observations for criteria in number's 1 and 2 must be made within 6 months of the most recent certification or recertification.

1. Nutritional impairment as evidenced by a Body Mass Index (BMI) below 22kg/m2                           Formula for calculating BMI:

BMI = 703 X (weight in pounds) / (height in inches)2

Current BMI = ___________________________________kg/m2 (Use Nomogram)

Patient is either declining enteral/parenteral nutritional support or has not responded to such nutritional support despite adequate caloric intake.

2. Significant disability as evidenced by a Karnofsky or Palliative Performance Scale Value (PPS) less than or equal to 40%.

Current Karnofsky or PPS = ___________%

3. Recumbent Anthropometry: Include as many measurements as you are able to obtain.

Recirtification Only

At the time of recirtification, recumbent anthropometry measurements may be substituted for BMI with documentation as to why BMI could not be measured. (i.e. patient in pain, immobility, availability of scale, etc.) These will be reviewed on a case-by-case basis.

Unable to obtain BMI due to:

_____________________________________________________________________________________

_____________________________________________________________________________________

4. If unable to obtain weight on admission, Adult Failure To Thrive cannot be used.  Debility, Unspecified can be used with documentation to support why Adult Failure to Thrive was not appropriate. (i.e. unable to obtain admission weight due to BMI>22kg/m2, Karnofsky>40%)

Unable to use Adult Failure to Thrive due to:

_____________________________________________________________________________________

_____________________________________________________________________________________

WORKSHEET FOR DETERMINING PROGNOSIS - ADULT FAILURE TO THRIVE

This worksheet is designed as a fact-finding tool and is not intended to be used to formulate diagnoses