Revised Guidelines for Adult Failure to Thrive


In the event a beneficiary presenting with a nutritional impairment and disability does not meet the medical criteria listed above, but is still thought to be eligible for the Medicare Hospice Benefit, an alternate diagnosis that best describes the clinical circumstances of the individual beneficiary should be selected (e.g. 783.21 “abnormal loss of weight” and 799.4 “Cachexia”)

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When to use AFTT (Adult Failure to Thrive)

  • For those Pt’s who have a large unexplained weight loss and have
    • BMI of < 22
    • PPS/Karnofsky of 40% or <

When to use Cachexia

  • For Pt’s who have large unexplained weight loss and present as cachectic
    • but have a PPS of > 40% and
    • are declining (baseline weight is low, weight loss is low, but proportional weight loss is as significant as a large weight loss in a larger person)

When to use abnormal loss of weight

  • For Pt’s who have experienced significant unexplained weight loss and
    • declining PPS
    • BMI is 22 or >

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