ICD-10 R64
Billable / Specific HCC v28: 21 CCCachexia
About ICD-10-CM R64
ICD-10-CM code R64 represents Cachexia. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R64). The 2026 edition of ICD-10-CM R64 became effective on October 1, 2025.
Coding Tips for R64
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
R64 is a CMS-HCC v28 risk-adjustment code (category 21). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
R64 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 1 Excludes
Pure excludes, these codes can never be coded together with R64. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- abnormal weight loss (R63.4)
- cachexia due to underlying condition (E88.A)
- nutritional marasmus (E41)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Cachexia. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for R64
Local Coverage Determinations (LCDs) from CMS MACs that list R64 as a covered diagnosis.
Showing top 10 of 34 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R64.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with R64
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert R64 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| R64 | 7994 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To R64
Other codes in section R50-R69 (General symptoms and signs).
ICD-10 R64, Billing FAQ
Is ICD-10 code R64 billable? +
Yes, R64 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for R64? +
Type 1 Excludes (never code together with R64): abnormal weight loss (R63.4); cachexia due to underlying condition (E88.A); nutritional marasmus (E41)
Does R64 affect Medicare Advantage HCC risk adjustment? +
Yes. R64 maps to CMS-HCC v28 category 21. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is R64 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does R64 map to? +
Per CMS GEMs, R64 maps to ICD-9 codes: 7994. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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