Hospice Eligibility for Adult Failure to Thrive (AFTT)

CMS policy states, "Both “debility” and “adult failure to thrive” are considered nonspecific, symptom diagnoses according to ICD-9-CM/ICD-10-CM coding guidelines. Adult failure to thrive (AFTT) and debility are not to be used as the principal hospice diagnosis (ICD code) on the Medicare claim form."


Adult failure to thrive is associated with multiple underlying conditions. The hospice principal diagnosis should list the the diagnosis that most contributes to a life expectancy of six months or less. For example, list the medical condition that led to the debility (malignant neoplasm, end-stage renal disease, COPD).


AFTT can be listed as a secondary or related condition that would benefit from hospice care. Comorbidities are an important factor in the overall status of an individual and should be documented.


The medical criteria below support the prognosis for patients with adult failure to thrive syndrome.


Criteria 1 and 2 MUST be met; factor 3 will lend support to terminal status. The patient would meet criteria if ALL of the following are met:

1. Irreversible nutritional impairment, as evidenced by both of the following:


  • Body Mass Index (BMI) will be less than 22kg/m^(BMI (kg/m^2) =703x (weight in pounds) / (height in inches) ^2).
  • Declines enteral/parenteral nutritional support OR has not responded to such support, despite an adequate caloric intake

AND

2. Significant Disability as evidenced by the Palliative Performance Scale (PPS) equal to or less than 40 percent.

3. Other variables lending support to terminal diagnosis include the following:


  • Recurrent or intractable infections, such as pneumonia or other URI, sepsis, or UTI
  • Decreasing serum albumin or cholesterol
  • Dysphagia leading to recurrent aspiration and inadequate oral intake documented by the decreasing food portion consumption
  • Nausea/vomiting poorly responsive to treatment
  • Diarrhea, intractable
  • Generalized pain
  • Decline in systolic blood pressure to below 90 or progressive postural hypotension
  • Edema
  • Change in level of consciousness
  • Abnormal electrolyte levels
  • Progressive 3-4 stage pressure ulcers

Adult failure to thrive syndrome, or geriatric failure to thrive, always includes two defining clinical elements; nutritional impairment and disability. The nutritional impairment and disability associated with the adult failure to thrive syndrome may be severe enough to impact short-term survival. Adult failure to thrive may manifest as an irreversible progression in the patient’s nutritional impairment/disability, despite a trial of therapy.


Physicians and admissions coordinators at our local programs are available for consultation.

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