Home Health ICD-9/ICD-10 Alert

Published on Wed Jun 12, 2013 PDF

Look to comorbidities that contribute to terminal status.

“‘Debility’ is medically defined as: an unspecified syndrome characterized by unexplained weight loss, malnutrition, functional decline, multiple chronic conditions contributing to the terminal progression, and increasing frequency of outpatient visits, emergency department visits and/ or hospitalizations,” the Centers for Medicare & Medicaid Services says in the 2014 hospice payment proposed rule.

“‘Adult Failure to Thrive’ is often used interchangeably with ‘Debility’ as a primary hospice diagnosis,” CMS says. But AFTT is its own separate condition defined as “undefined weight loss, decreasing anthromorphic measurements, and a Palliative Performance Scale < 40 percent,” CMS explains.

Both conditions are associated with “multiple primary conditions,” CMS says.

Patients diagnosed with “debility” may have multiple comorbidities that wouldn’t individually classify the patient as terminally ill. But considered as a group, these additional diagnoses “will contribute to the terminal status of the individual,” CMS says.

Hospice claims data for 2012 showed that beneficiaries with a principal hospice diagnosis of “debility” and additional secondary diagnoses, most often had congestive heart failure, coronary artery disease, heart disease, atrial fibrillation, Parkinson’s disease, Alzheimer’s disease, renal failure, chronic kidney disease, or chronic obstructive pulmonary disease, CMS says.

“’Adult failure to thrive’ is also associated with multiple primary conditions contributing to the physical and functional decline of the individual,” CMS says. “Four syndromes known to be individually predictive of adverse outcomes in older adults are repeatedly cited as prevalent in patients with “adult failure to thrive” — impaired physical functioning, malnutrition, depression, and cognitive impairment.”

2012 Hospice claims data for beneficiaries with a principal hospice diagnosis of “adult failure to thrive,” and secondary diagnoses, show that pneumonia, cerebral vascular accident (stroke), atrial fibrillation, heart disease, Alzheimer’s disease, congestive heart failure, and Parkinson’s disease are among the most common secondary diagnoses, CMS says.

“Debility and AFTT have traditionally been used for a variety of patients who have multiple conditions or just give up,” says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. “However when CMS does their medical review they see that lots of these patients have been terminal for years and their palliative performance scale doesn’t really indicate they’re that sick. They have these ambiguous vague symptom diagnoses as terminal diagnoses and CMS denies the claims.”