ICD-10 Code R62.7 for Adult Failure to Thrive in 2025
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code for adult failure to thrive in 2025 is R62.7. This code is found within Chapter 18 of the ICD-10-CM, which covers 'Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified'. It is important for coders and healthcare providers to understand that R62.7 represents a syndrome of decline, often with multiple contributing factors, rather than a single, distinct disease. Given its symptomatic nature, careful clinical documentation is essential for appropriate and compliant use of this code, especially when other more specific diagnoses are present.
Clinical Description of Adult Failure to Thrive
Adult failure to thrive (AFTT) is a multifaceted syndrome commonly affecting older, frail patients. It is characterized by progressive functional and cognitive decline, malnutrition, and unexplained weight loss. The condition is not a specific diagnosis in itself but a collection of symptoms or signs of decline. For a diagnosis of AFTT, health experts look for several key factors:
- Unexplained weight loss: Significant weight loss that cannot be attributed to another specific medical cause, despite adequate nutritional support.
- Malnutrition: The presence of nutritional impairment, which can be quantified by a Body Mass Index (BMI) below a certain threshold.
- Functional decline: A progressive loss of the ability to perform daily activities, which can be measured using scales such as the Palliative Care Performance Scale.
- Psychological factors: This often includes symptoms such as depression, social withdrawal, and apathy.
- Fatigue and decreased physical activity: A general and persistent feeling of weakness and reduced mobility.
Proper Application of ICD-10-CM Code R62.7
Using R62.7 correctly requires a nuanced approach to coding. While it is the correct code for the syndrome itself, coding guidelines emphasize identifying and reporting the underlying conditions whenever possible.
- Code the underlying condition first: If a more specific cause is identified (e.g., congestive heart failure, cancer, or advanced dementia), that should typically be coded as the primary diagnosis.
- Use R62.7 as an ancillary code: R62.7 is then used as a secondary or additional code to capture the full scope of the patient's condition, especially when the decline is multifactorial.
- Ensure comprehensive documentation: Providers must ensure that the patient's medical record clearly supports the use of R62.7 by documenting weight loss, functional decline, and the exclusion of other primary conditions.
For hospice care, specific rules apply. The Centers for Medicare & Medicaid Services (CMS) have specified that R62.7, along with other unspecified diagnoses, cannot be used as the principal diagnosis for a hospice claim. Instead, documentation must support an irreversible progression of nutritional impairment and disability to justify hospice eligibility.
Comparison of Related ICD-10-CM Codes
Understanding the distinction between R62.7 and other similar codes is critical for accurate coding. The following table provides a comparison of R62.7 with other codes that may represent overlapping symptoms.
| ICD-10 Code | Description | Key Distinction from R62.7 |
|---|---|---|
| R62.7 | Adult failure to thrive | A multifactorial syndrome of decline involving weight loss, functional decline, and malnutrition, without a single dominant cause. |
| E46 | Unspecified protein-calorie malnutrition | Used when lab results or other documentation confirm malnutrition, but the specific type or severity is not detailed. R62.7 might be more appropriate if the syndrome extends beyond nutritional issues alone. |
| R64 | Cachexia | Use specifically when the patient has cachexia, which is a state of severe weight loss, muscle wasting, and fatigue, often associated with a dominant underlying disease like cancer. |
| R63.4 | Abnormal weight loss | A more general code for unexplained weight loss, which could be a component of AFTT but does not encompass the full syndrome of functional and psychological decline. |
| Z59.4 | Lack of adequate food | A social determinant of health code used to indicate that the patient's failure to thrive is related to a lack of access to food, rather than a medical condition. |
Causes of Adult Failure to Thrive
AFTT is not a normal part of aging but a sign of underlying issues that require medical evaluation. The causes are diverse and can be broadly categorized into physical, psychological, and social factors.
- Physical factors: Chronic diseases are a major contributor, including cancer, chronic renal insufficiency, congestive heart failure, and chronic lung disease. Other issues like dysphagia (difficulty swallowing), side effects from multiple medications, and sensory deficits can also play a role.
- Psychological factors: Mental health conditions like depression and dementia are frequently associated with AFTT, leading to poor food intake, social isolation, and overall decline. Substance abuse, such as alcohol or drug use, can also contribute.
- Social factors: Social isolation, financial difficulties, loss of a loved one, and limited access to nutritious food can precipitate or worsen AFTT.
Conclusion
For 2025, the ICD-10 code for adult Failure to thrive remains R62.7. This code is used for the multifactorial syndrome of decline seen predominantly in elderly patients and characterized by unexplained weight loss, malnutrition, functional impairment, and often, psychological distress. Accurate coding necessitates using R62.7 as an ancillary diagnosis when a more specific primary cause is identified. Comprehensive clinical documentation is paramount to support the use of this code, ensuring appropriate patient care and compliance with billing guidelines. UpToDate - Failure to thrive in older adults: Evaluation is a helpful resource for further clinical information and evaluation protocols.
