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:
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:
|262||E43||Unspecified severe protein-calorie malnutrition|
|263.0||E44.0||Moderate protein-calorie malnutrition|
|263.1||E44.1||Mild protein-calorie malnutrition|
|263.8||E46||converts approximately to:2013 ICD-10-CM E46 Unspecified protein-calorie malnutrition|
|263.9||E46||Applicable To Malnutrition NOSProtein-calorie imbalance NOS|
|278.01||E66.01||Morbid (severe) obesity due to excess calories|
|783.22||R63.6||Underweight. 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)|
|783.21||R63.4||Abnormal weight loss|
|799.4||R64||Cachexia . Applicable To Wasting syndrome Code First underlying condition, if known Type 1 Excludes abnormal weight loss (R63.4) nutritional marasmus (E41).|
|V85.0||Z68.1||Body mass index (BMI less than 19, adult.|
Unspecified severe protein-calorie malnutrition
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