malnutrition and cachexia

Unknown
in CDI Talk Archive
What are the thoughts out there?
If a patient has mild malnutrition and the physician says they are cachectic.
Do you pick up both?


Charlene Thiry RN, BSN, CPC, CCDS
Clinical Documentation Specialist
Quality Resources
Menorah Medical Center

Comments

  • sharon.colesharon.cole
    edited May 2016
    Do you have a BMI or IBW that is exceedingly low? Has there been any documented weight loss? Is the patient able to eat/feed themselves? What is the prealbumin? I would check other documentation to see what you have, then maybe speak with the physician about the level of malnutrition.
    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    Sharon.cole@phn-waco.org
  • vdavis2vdavis2
    edited May 2016
    You are able to code both! (I won this one in a "little debate"!) ... Cachexia-think wasting syndrome/loss of muscle mass/skeletal appearance... The attached article explains this pretty well.
    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
  • Unknown
    edited May 2016
    Thank-you Vickie.
    I agree as one can have malnutrition without being cachectic. However my coding manager says not and I needed reinforcements.
    BMI - 15.3 pt is 5' 8" and 100# No prealbumin. I queried the nutritional status and the answer was "mild malnutrition". Cachexia was well documented in the record also.

    Thanks again.
    Charlene
  • vdavis2vdavis2
    edited May 2016
    Good luck Charlene!!! -Vicki J

    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Hmmm. From a clinical standpoint it seems clear that cachexia is not inherent to malnutrition (or vice versa). Let's think about our obese malnourished patients. However, I can see where this may be confusing for coding purposes. We code both here.
    And "mild malnutrition" for the patient you described seems strange (though obviously numbers can be deceiving). Do you work with nutrition to get an accurate diagnosis?

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    From a Coding Standpoint, one may code both Cachexia as well as malnutrition.

    See the Index of Diseases for this guidance, and remember, the Index 'trumps' all coding advice:

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • Unknown
    edited May 2016
    OK. I looked up cachexia in my book. Are you saying because it does not take me to malnutrition this allows one code as an additional diagnosis? Coding manager told me it "was not appropriate as it was a symptom code".
    When I go to the tabular it tells me to "code first underlying condition, if known".
    So in sequencing the mild malnutrition goes first followed by cachexia?
    I need to be able to put it into words for my (off site) coding manager so she can understand my thought process.
    When we had our coder in the facility it was so easy to just ask for their consideration. . . now not so easy.
    Charlene
  • dvitalone1dvitalone1
    edited May 2016
    We just had 3M consultants here last week and I asked them. You code malnutrition along with the cachexia, both which are severity drivers.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    The Index for Cachexia WITH malnutrition = assign the code for Cachexia

    * When you assign the code for malnutrition, note there is not an exclusion note stating : "Excludes Cachexia"

    * When you assign the code for Cachexia, there is not an exclusion note stating: "Excludes Malnutrition".
    The reasons are for the clinical justifications earlier stated in this thread, in my opinion.
    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I think the coder is looking at this in reverse. I think the assumption should be that we code all relevant dx unless we are specifically told not to code two dx simultaneously (as in an excludes note or coding clinic). So instead of the onus being on you to say that they CAN be coded together, she should be the one finding guidance suggesting you cannot code them together.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • Unknown
    edited May 2016
    I have to smile. How often does the cart get put before the horse?
    Since the final word ends with the coder (or coding manager) the clinical documentation specialist really has to make a solid case in order to move forward.
  • Unknown
    edited May 2016
    Excellent. Thank-you.
    I have enough info to write a response.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Katy is correct - although, I understand the opposing view that 'one does not normally assign a symptom code with an inherent disease". However, as others stated -
    "Hmmm. From a clinical standpoint it seems clear that cachexia is not inherent to malnutrition (or vice versa). Let's think about our obese malnourished patients."

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • vdavis2vdavis2
    edited May 2016
    Yes, I would say they would appear to be "skeleton-like" and the BMI really is suggestive of something more than just mild malnutrition. -V

    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Ha! Maybe I should clarify. I completely understand that in the end, it is up to coding to make the determination about whether they will code a dx or not. I just think its strange to ask CDI to explain why we DO code something when generally, this is the default. The better question is when are we NOT to code a dx. If there is no coding clinic directly speaking to this issue (I admit, I have not looked) and no excludes note, how can we "prove" it should be coded. Its kind of like proving unicorns don't exist.
    Since it is the coder actually coding the record, of course they have the final say though....

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I looked, and could not find a Coding Clinic addressing this particular topic. The software available to me in that regard is 'not the best', however - but, generally, it is okay and current.
    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • vdavis2vdavis2
    edited May 2016
    Bummer... My little girl will be sad to hear that Unicorns do not exist! (Just thought everyone could use a laugh! J Happy Monday!)
    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Vicki - This means to me that you 'should' apply both codes...it is not prohibited in C. Clinic and the Index instructs one to do so.
    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    :)

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • paxnerospaxneros
    edited May 2016
    Paul! You use Quadramed too! (Sorry- very OT but sometimes it feels like our facility is the only one not using 3M...)

    Norma
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    From what I can gather, 3M offers a more refined product with great tools. However, our system went with Quadramed – I think it is ‘adequate’. But, sometimes I can’t locate all pertinent references in a timely manner. 3M does costs quite a bit more.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • bosankorbosankor
    edited May 2016
    Nuance has acquired JATA and Quadramed as well as partnered with 3M on their CDI software – just announced yesterday at the AHIMA 2012 Convention
  • sharon.cooper@owensborohealth.orgsharon.cooper@owensborohealth.org
    edited May 2016
    Yes, we rec'd emails from both today.

    Sharon Cooper, RN-BC, CCS, CDIP, CCDS
    AHIMA-Approved ICD-10-CM/PCS Trainer
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