R64

HCC Category Mapping

What This Code Means

Severe wasting and loss of muscle mass and body weight, often seen in advanced cancer, chronic illness, or severe malnutrition.

Coding Tips

• •Cachexia is a sign of serious underlying disease; always investigate and code the primary condition
• •Document the degree of weight loss and functional decline to support medical necessity

Clinical Significance

Cachexia represents severe protein-energy malnutrition with significant muscle wasting that dramatically increases morbidity and mortality risk. This condition indicates advanced disease state requiring intensive nutritional intervention and impacts multiple body systems and functional status.

Documentation Requirements

• ✓Documentation of severe weight loss (>5% in 6 months)
• ✓Evidence of muscle wasting and weakness
• ✓Underlying disease process causing cachexia
• ✓Nutritional assessment results
• ✓Functional status decline
• ✓Laboratory values showing protein deficiency
• ✓Interventions attempted for nutritional support
• ✓Prognosis and goals of care discussions

Commonly Confused Codes