Tips for Assessing Malnutrition
Jan 7, 2015
by Dr. Jon Elion

In my previous blog entry, I discussed 6 key elements needed in the documentation of potential malnutrition. Now let’s look at some pointers on reviewing the chart of a patient where the diagnosis of malnutrition is being considered.

There have been several well-publicized instances where hospitals have gotten into trouble for their coding and billing practices related to various malnutrition diagnoses. A common thread through all of these occurrences was the lack of a clinical assessment that suggested malnutrition in the first place. The diagnosis should never be considered solely on the basis of a laboratory abnormality, and the clinical guidelines are meant to be applied to patients who have some clinical indication that malnutrition may be present.

The following practical approach will help to maximize the quality of the documentation related to malnutrition while avoiding some key potential pitfalls:

  • Be sure that there is a clinical sense of a potential nutritional disturbance before proceeding to apply any guidelines for its assessment
  • Verify that at least two of the six characteristics from the ASPEN Guidelines are present to further confirm the diagnosis
  • Avoid the temptation to query the physician about malnutrition (or to code for it) when the only basis is an abnormal lab result
  • Encourages your physicians to use the 6 Key Elements for Documenting Malnutrition to provide complete documentation
  • Pay attention to the potential presence of other conditions and diagnoses that may produce or be associated with malnutrition (pancreatic cancer, lung cancer, head and neck cancer, gastrointestinal cancer, stroke, chronic obstructive pulmonary disease)
  • Don’t confuse the need for nutrition for the presence of malnutrition

A collaborative approach in the evaluation and management of nutrition and malnutrition should include, at the very least, physicians, nurses, and registered dieticians. You should consider implementing a policy that requires a dietary consultation on the chart before any of the malnutrition diagnoses can be coded.

The following is a helpful summary of ICD9 and ICD10 codes related to malnutrition:

ICD-9ICD-10Description
262E43Unspecified severe protein-calorie malnutrition
263.0E44.0Moderate protein-calorie malnutrition
263.1E44.1Mild protein-calorie malnutrition
263.8E46converts approximately to:2013 ICD-10-CM E46 Unspecified protein-calorie malnutrition
263.9E46Applicable To Malnutrition NOSProtein-calorie imbalance NOS
278.01E66.01Morbid (severe) obesity due to excess calories
783.22R63.6Underweight. Use Additional code to identify body mass index (BMI), if known (Z68.-) Type 1 Excludes abnormal weight loss (R63.4) anorexia nervosa (F50.0-) malnutrition (E40-E46)
783.21R63.4Abnormal weight loss
799.4R64Cachexia . Applicable To Wasting syndrome Code First underlying condition, if known Type 1 Excludes abnormal weight loss (R63.4) nutritional marasmus (E41).
V85.0Z68.1Body mass index (BMI less than 19, adult.
260E40E42KwashiorkorMarasmic Kwashiorkor
261E41
E42
E43
Marasmus
Marasmic Kwashiorkor
Unspecified severe protein-calorie malnutrition

 

 

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