Debility, unspecified: a terminal diagnosis

To determine whether the diagnosis "debility, unspecified" (ICD-9 code 799.3) is appropriate for use with terminally ill patients and to define the criteria for assigning the diagnosis.

A survey of patient charts to determine the clinical characteristics of a defined cohort.

A comprehensive hospice program with average daily census over 500 patients.

All patients who died in the hospice program during the period from January through October, 1993 and were assigned a diagnosis of "debility, unspecified" (ICD-9, 799.3).

For each patient, the following information was recorded: demographics, level of function (ability to carry out activities of daily living), presence of major system disease, other illnesses, any other appropriate ICD-9 coded diagnosis.

The diagnosis of "debility, unspecified" was confirmed in 50 out of 53 cases. All 50 patients exhibited multiple comorbid conditions. Major organ system impairment included central nervous system (96 percent of patients), cardiopulmonary (76 percent of patients), skin integrity (42 percent of patients), and sepsis at the time of admission (30 percent of patients). The average survival for these patients was 67 days and the median survival was 20 days. In none of the 50 patients was there a single major system impairment of a degree to warrant a specific terminal diagnosis.

The use of the ICD-9 code 799.3 "debility, unspecified" as a terminal diagnosis was confirmed to be appropriate based on survival and hospice length of stay data and on the fact that no patients exhibited a singular major system disease sufficient to support a terminal prognosis. A decision tree for assigning the diagnosis is presented.