ICD-10 Guide

R64

Cachexia

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/05/2025

Code Description

ICD-10 R64 is a billable code used to indicate a diagnosis of cachexia.

Key Diagnostic Point:

Cachexia is a complex metabolic syndrome characterized by severe weight loss, muscle wasting, and a significant decline in overall health, often associated with chronic diseases such as cancer, heart failure, and chronic obstructive pulmonary disease (COPD). It is not merely a result of reduced caloric intake but involves a multifactorial process that includes inflammation, metabolic dysregulation, and hormonal changes. The clinical significance of cachexia lies in its association with increased morbidity and mortality, making it crucial for healthcare providers to recognize and address this condition in patients with chronic illnesses.

The ICD-10 code R64 specifically identifies cachexia and is used to document this condition in medical records. It is important for clinicians to accurately code cachexia to ensure appropriate management and treatment plans are implemented. The usage guidelines for R64 emphasize the need for comprehensive patient evaluation and documentation that supports the diagnosis of cachexia, including assessments of weight loss, muscle mass, and underlying disease processes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Multifactorial nature of cachexia
Association with various chronic conditions
Need for comprehensive documentation

Audit Risk Factors

Inadequate documentation of weight loss
Failure to link cachexia to underlying conditions
Misinterpretation of cachexia as simple malnutrition

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Palliative Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

From an administrative perspective, accurate coding of cachexia can influence population health metrics and healthcare trends. As awareness of cachexia grows, healthcare systems may implement targeted interventions to address this condition, ultimately leading to better resource allocation and improved patient care strategies. Monitoring trends in cachexia prevalence can also inform public health initiatives aimed at managing chronic diseases more effectively.

ICD-9 vs ICD-10

The clinical impact of the R64 code category is significant, as it highlights the importance of recognizing and managing cachexia in patients with chronic illnesses. Effective management of cachexia can lead to improved patient outcomes, reduced hospitalizations, and enhanced quality of life. Furthermore, addressing cachexia is essential for meeting quality measures in healthcare, as it is often associated with increased healthcare utilization and costs. From an administrative perspective, accurate coding of cachexia can influence population health metrics and healthcare trends. As awareness of cachexia grows, healthcare systems may implement targeted interventions to address this condition, ultimately leading to better resource allocation and improved patient care strategies. Monitoring trends in cachexia prevalence can also inform public health initiatives aimed at managing chronic diseases more effectively.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the patient's underlying conditions and the severity of cachexia, necessitating a thorough understanding of payer policies. Common billing practices include using R64 in conjunction with codes for the primary disease process and any related treatments or interventions.

Resources

Clinical References

•
Official ICD-10 Guidelines for R64

Coding & Billing References

•
Official ICD-10 Guidelines for R64

Frequently Asked Questions

What conditions are included in R64?

R64 covers cachexia associated with various chronic diseases, including cancer, heart failure, and chronic obstructive pulmonary disease (COPD). It is important to note that cachexia is distinct from simple malnutrition and requires specific clinical criteria for diagnosis.

When should I use R64 codes?

R64 should be used when a patient presents with cachexia, characterized by significant weight loss and muscle wasting, particularly in the context of chronic diseases. It is essential to document the clinical findings and the relationship to underlying conditions.

What documentation is required for R64?

Documentation for R64 should include clinical assessments of weight loss, muscle mass evaluation, and a clear link to any underlying chronic conditions. Detailed notes on the patient's nutritional status and any interventions should also be included.

ICD-10 R64 is a billable code used to indicate a diagnosis of cachexia.

Key Diagnostic Point:

The ICD-10 code R64 specifically identifies cachexia and is used to document this condition in medical records. It is important for clinicians to accurately code cachexia to ensure appropriate management and treatment plans are implemented. The usage guidelines for R64 emphasize the need for comprehensive patient evaluation and documentation that supports the diagnosis of cachexia, including assessments of weight loss, muscle mass, and underlying disease processes.