Medicare Guidelines for Non-Cancer

ADULT FAILURE TO THRIVE

  1. BMI must be < 22 kg/m2

  2. Reason for Decline: (check all that apply)

·       Not responding to nutritional support despite

         adequate caloric intake

·       Patient declining enteral/parenteral support

  3. Karnofsky Score: (must be 40 or below)

·       40 – Disabled / require much assistance / frequent

         medical care

·       30 – Severely disabled / require close monitoring

·       20 – Very sick / active supportive Tx

·       10 – Moribund / Imminent death

 

**Comorbidities increase patient’s hospice

appropriateness**

 

    ICD-9 Codes that support medical necessity:

o   783.41 Failure to Thrive

o   783.7 Adult Failure to Thrive

o   799.3 Debility, unspecified

o   799.89 Other ill-defined conditions

o   799.9 Other unknown and unspecified causes

            of morbidity and mortality