malnutrition

laura.jansen

Have a patient admitted with hyponatremia, nausea, vomiting for egd evaluation. Has a known hx of metastatic ca with primary unknown. The md documents in the body of his h&p that the patient is unable to take in any solids & is becoming emaciated & cachectic. On the egd they found esophageal candidiasis. Do you think it is appropriate to code the cachexia & emaciation. His bmi is normal & no albumin is documented. Thoughts?



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Unknown

Yes, in our hospital, our coders would code these 2 conditions since it is
documented by a physician. His apparence must gave MD the reason to document
these.

robert.hodges2

I won't pretend to be a coding expert, but if the provider documents it
and does so consistently then I would say yes, you can code it.



Robert



Robert S. Hodges, BSN, MSN, RN

Clinical Documentation Improvement Specialist

Aleda E. Lutz VAMC

Mail Code 136

1500 Weiss Street

Saginaw MI 48602



P: 989-497-2500 x13101

F: 989-321-4912

E: Robert.Hodges2@va.gov

Unknown

I would take the cachexia and if the physician has documented emaciation query for malnutrition.
A normal BMI does not mean an individual is not malnourished. Many morbid obese individuals suffer from malnutrition.

Do you have standard criteria for malnutrition?

Here we use visible wasting of muscle/tissue; severe pallor, edema/fluid retention. low serum proteins, documented weight loss, dietary consult, inability to consume adequate caloric intake, low pre-albumin etc.

Charlene

sbeatty

I would take this route as well. I'd ask if the MD considered the
findings indicative of a nutritional condition, and if so, would he
please document any diagnosis appropriate to reflect his E & M.



Sandy Beatty, RN, BSN, C-CDI

Clinical Documentation Specialist

Columbus Regional Hospital

Columbus, IN

(812) 376-5652

sbeatty@crh.org

"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens

atrickey

I would be leary to code these unless documented as due to malnutrition.


I would query for the underlying condition causing cachexia and
emaciation.

Avery E. Trickey, RHIA
Clinical Documentation Specialist
BroMenn Healthcare
Normal, IL 61761
309-268-5394
atrickey@bromenn.org

[Deleted User]

http://www.hcpro.com/content/235434.pdf
Dr. Arnott wrote a good article about malnutrition documentation.

There's also some good articles on the ACDIS Blog. This one contains links to other posts: http://blogs.hcpro.com/acdis/2009/08/more-on-potential-pitfalls-of-malnutrion-documentation/

dallend@einstein.edu

Our coders would code the cachexia. I would also check for the nutrition consult (if done) - you may be able to query for malnutrition. The MD may not have documented the albumin (our physicians don't always document the results in their notes) but I would check the labs just to determine if there is an albumin level and total protein level.
We have many patients with normal or elevated BMIs who have a diagnosis of malnutrition.

Unknown

This is what our Dietician's came up with as a tool to help them.

Note the letters in ( ) are for the references found on page 2.
The 'Required Groups' indicate that you need at least one indictor from each of the listed groups to make that diadnosis. i.e. malnutrition of moderate degree, you need one indicator from group 1 and 2.

Hope this is helpful. I thought it was and have shared it with our physicians.


Charlene

lspryszak

Wonderful! Thanks for sharing!!!

[Deleted User]

Check out this article from the CDI Journal archives, too.
http://www.hcpro.com/content/235434.pdf
Also would you be willing/interested in sharing that information on the Forms & Tools Web site?

Unknown

Our Dietician's put this document together. I think they were tired of all my questions asking if they could document such and such!!!

I believe it stands for:
the University of Pittsburgh Medical Center Health System

Charlene

dsmith12h@aol.com

When ever there are abnormal lab values, imaging, pathology, symptoms, signs etc. documented in the medical record and there is treatment, evaluation, monitoring or criteria that basically meets the UHDDS definition for other diagnoses but there is no diagnosis-- I feel a query should be posed as to the significance of the documented data. If you have to ask yourself " what are they treating" or "why are they speaking only in terms of clinical data"-- a query should be posed. Clinical staff may understand what is going on and what is being treated but I don't think that can be assumed to be the rule. For continuity of care the data that is documented should be clear for all members of the healthcare team who encounter the medical record clinical and non-clinical). If it isn't clear to the person reviewing the record, always seek clarification as to the significance of the findings.

In the example that is presented, if treatment, monitoring, evaluation, etc., is being provided and you believe Malnutrition may be may evident-- then yes, query.

dsmith12h@aol.com

I forgot to add--- the forms and tools resource on ACDIS wedsite has examples of queries that have criteria on them. They may help as a guide for discussing criteria in your meeting.



-----Original Message-----
From: CDI Talk
To: dsmith12h
Sent: Tue, Oct 4, 2011 7:25 pm
Subject: Re: [cdi_talk] Malnutrition


When ever there are abnormal lab values, imaging, pathology, symptoms, signs etc. documented in the medical record and there is treatment, evaluation, monitoring or criteria that basically meets the UHDDS definition for other diagnoses but there is no diagnosis-- I feel a query should be posed as to the significance of the documented data. If you have to ask yourself " what are they treating" or "why are they speaking only in terms of clinical data"-- a query should be posed. Clinical staff may understand what is going on and what is being treated but I don't think that can be assumed to be the rule. For continuity of care the data that is documented should be clear for all members of the healthcare team who encounter the medical record clinical and non-clinical). If it isn't clear to the person reviewing the record, always seek clarification as to the significance of the findings.

In the example that is presented, if treatment, monitoring, evaluation, etc., is being provided and you believe Malnutrition may be may evident-- then yes, query.



-----Original Message-----
From: CDI Talk
To: dsmith12h
Sent: Tue, Oct 4, 2011 6:43 pm
Subject: [cdi_talk] Malnutrition


When do you query for malnutrition?
Lab data (pre-alb, protein, etc)?
eports of unintended weight loss?
hronic illness (cancer with weight loss)?
MI?
utritional supplementation with Tube feeds or TPN?
ther?
We have a meeting with nutrition to discuss malnutrition next week and in the
ast we have been at odds about what criteria deserves a query.
'm just wondering what others query on.
Thanks!
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katysuegood@gmail.com

Thanks for your input.

So, if someone is on TPN/Tube fed, are we treating malnutrition? or have we effectively prevented malnutrition?

I have not been querying for malnutrition solely based on a patient being on TPN. However, another CDI was telling me that they thought it was appropriate because gnerally the pt has been NPO for several days before requiring TPN. Also, how else to we capture the huge resources being used when a patient is on TPN?
I think out nutritionists would argue that we are effectively meeting the nutritional needs of our patients who are receiving TPN and tube feedings.

thanks.

katysuegood@gmail.com

I have a similar query as the ones I have seen in the "forms and tools" tab.
We input Labs (protein/pre-A/albumin), BMI, if there has been a dietary consult and other pertinent data (weight loss, cancer dx)if applicable/available and ask for a diagnosis. Our nutritionists have complained that they do not feel that lab data is a good indicator of nutritional status and have not been especially happy about what triggers a query.

robert.hodges2

From http://www.merriam-webster.com/dictionary/calorie:

Calorie:
"2a : a unit equivalent to the large calorie expressing heat-producing or energy-producing value in food when oxidized in the body 2b : an amount of food having an energy-producing value of one large calorie"

I wouldn't necessarily query, but that's me.

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
 
P: 989-497-2500 x13101
F: 989-321-4912
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-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, October 25, 2011 10:27 AM
To: Hodges, Robert
Subject: [cdi_talk] malnutrition

I have a physician documenting severe protein energy malnutrition, the coding book and our encoder does not appear to accept energy in place of calorie. Does anyone have a reference that shows energy can be interchanged with calorie or do I need to query the physician to document calorie?

Thank you,
Tara
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cstukenberg

I would query if there is a doubt.....

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, October 25, 2011 9:27 AM
To: Stukenberg, Colleen M.
Subject: [cdi_talk] malnutrition

I have a physician documenting severe protein energy malnutrition, the coding book and our encoder does not appear to accept energy in place of calorie. Does anyone have a reference that shows energy can be interchanged with calorie or do I need to query the physician to document calorie?

Thank you,
Tara
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dvitalone1

Energy=calorie I wouldn’t query.


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Unknown

While, standard English would lead one to believe that energy might
equal calorie. Actually calorie is a unit of heat. Unless you are
satisfied with coding this as severe malnutrition unspecified and you
think the patient's clinical picture reflects "severe protein calorie
malnutrition", I would query for clarification. Donna

Donna Kent, RN, BSN, CCDS
Manager, Clinical Documentation Integrity Program
Clinical Quality and Accreditation
Torrance Memorial Medical Center
ph.:310 784-6884 fax:310 784-6899
donna.kent@tmmc.com
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, October 25, 2011 8:26 AM
To: Kent, Donna K.
Subject: RE: [cdi_talk] malnutrition

Energy=calorie I wouldn't query.


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ddouthit

Dawn,

Unfortunately you will need to query the physician, but at least the dietician has given you good clinical indicator.

Dorie Douthit, RHIT,CCS

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, August 03, 2012 11:20 AM
To: Douthit, Dorie
Subject: [cdi_talk] Malnutrition

If a physician documents "malnutrition" and dietician's assessment is "other severe protein calorie malnutrtion", can you code "other severe protein calorie malnutrition" or do you need to query physician for the specificty?

Thanks!
Dawn Vitalone, RN
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katysuegood@gmail.com

My understanding is that you still need to query for specificity. We include the Dieticians assessment in the query.
We actually have a system set up where the dieticians email us anytime they dx a patient with malnutrition so that we can query on it if needed.

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

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, August 03, 2012 11:20 AM
To: Kathryn Good
Subject: [cdi_talk] Malnutrition

If a physician documents "malnutrition" and dietician's assessment is "other severe protein calorie malnutrtion", can you code "other severe protein calorie malnutrition" or do you need to query physician for the specificty?

Thanks!
Dawn Vitalone, RN
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katysuegood@gmail.com

Here's ours

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

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 06, 2013 6:30 AM
To: Kathryn Good
Subject: [cdi_talk] malnutrition

I guess I am on the malnutrition band wagon....

Does anyone have a malnutrition query they would be willing to share?


Thanks in advance.



Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
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don.cdi.rn@gmail.com

This documentation tip might also be helpful.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program
Vidant Health, Greenville NC
DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )


>>> "CDI Talk" 9/6/2013 10:30 AM >>>
I guess I am on the malnutrition band wagon....

Does anyone have a malnutrition query they would be willing to share?


Thanks in advance.



Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug."- Samuel "Mark
Twain" Clemens
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katysuegood@gmail.com

Great Tip Don, we use something very similar for our MDs that our dieticians have provided.

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 06, 2013 7:27 AM
To: Kathryn Good
Subject: Re: [cdi_talk] malnutrition

This documentation tip might also be helpful.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program Vidant Health, Greenville NC DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )


>>> "CDI Talk" 9/6/2013 10:30 AM >>>
I guess I am on the malnutrition band wagon....

Does anyone have a malnutrition query they would be willing to share?


Thanks in advance.



Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens Confidentiality Notice: This email communication, including all attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited and may be unlawful. If you are not an intended recipient, please contact the sender by reply email and destroy all copies of the original message and attachments. Please note that this email and attachments may be copyright protected.

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Unknown

For those of you with an EMR, how do you circulate tip sheets for
physicians?

Linda Haynes
Legacy Health
lhaynes@lhs.org

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 06, 2013 8:34 AM
To: Haynes, Linda :CO Care Management
Subject: RE: [cdi_talk] malnutrition

Great Tip Don, we use something very similar for our MDs that our
dieticians have provided.

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 06, 2013 7:27 AM
To: Kathryn Good
Subject: Re: [cdi_talk] malnutrition

This documentation tip might also be helpful.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program Vidant Health,
Greenville NC DButler@vidanthealth.com (
mailto:mDButler@vidanthealth.com )


>>> "CDI Talk" 9/6/2013 10:30 AM >>>
I guess I am on the malnutrition band wagon....

Does anyone have a malnutrition query they would be willing to share?


Thanks in advance.



Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug."- Samuel "Mark
Twain" Clemens Confidentiality Notice: This email communication,
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lindenbm@bellsouth.net

We put a tip weekly in the physician newsletter.

Mary Lindenboom, RN, BSN, CCDS
Clinical Documentation Specialist
Flagler Hospital
400 Health Park Blvd.
St. Augustine, FL

katysuegood@gmail.com

We post them in dictation rooms and email them to providers. We also have a short PowerPoint presentation of tips that shows on a screen in the MD lounge.

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 06, 2013 8:54 AM
To: Kathryn Good
Subject: RE: [cdi_talk] malnutrition

For those of you with an EMR, how do you circulate tip sheets for
physicians?

Linda Haynes
Legacy Health
lhaynes@lhs.org

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 06, 2013 8:34 AM
To: Haynes, Linda :CO Care Management
Subject: RE: [cdi_talk] malnutrition

Great Tip Don, we use something very similar for our MDs that our
dieticians have provided.

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 06, 2013 7:27 AM
To: Kathryn Good
Subject: Re: [cdi_talk] malnutrition

This documentation tip might also be helpful.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program Vidant Health,
Greenville NC DButler@vidanthealth.com (
mailto:mDButler@vidanthealth.com )


>>> "CDI Talk" 9/6/2013 10:30 AM >>>
I guess I am on the malnutrition band wagon....

Does anyone have a malnutrition query they would be willing to share?


Thanks in advance.



Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

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lindenbm@bellsouth.net

That is a great idea!


Mary Lindenboom, RN, BSN, CCDS
Clinical Documentation Manager
Flagler Hospital
400 Health Park Blvd.
St. Augustine, FL

katysuegood@gmail.com

YES!
We have worked extensively with our Nutrition department in the past few years. In fact, one of our CDI's will be presenting a poster showcasing this work and I will be touching on this project in my presentation at the ACDIS conference.
Our dieticians use ASPEN criteria and do not use Albumin to substantiate dx since it is considered a poor indicator. They have no issue diagnosing Severe Protein Calorie Malnutrition and they use the verbiage we need for coding.
We are notified whenever they make a nutrition dx. We also let them know if we see a patient that we think is 'at risk' that has not been consulted. We have also set up a system where they are automatically notified when patients are admitted that were diagnosed with malnutrition in the past so that they can identify these patients and intervene more quickly.
We have also been involved in the building of their documentation templates so that we can make sure their documentation clearly establishes a dx with appropriate clinical indicators to prevent denials.

Let me know if you have more specific questions!

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, February 24, 2014 11:48 AM
To: Kathryn Good
Subject: [cdi_talk] Malnutrition

Has anyone worked on any projects with the dieticians in their facilities to make sure their documentation was assisting providers to make diagnosis that accurately reflect the patients nutritional status AND in a way that is recognized by code sets.

Have many hospitals moved to ASPEN criteria?

Many of our providers copy the words of dieticians. Dieticians frequently feel their hands are tied in being able to diagnose Severe malnutrition because the don't have an albumin- but the have a bmi 15, cancer, pressure ulcers and are started on TF or TPN.

It can be frustrating because they also say albumin is not a reliable indicator to assess nutritional status (yet it's what is missing to diagnose at times).

Has anyone had similar situations? and more importantly solutions?

Thanks for any input!

Ann Donnelly,RN,BSN,CCDS
ann.donnelly@sclhs.net
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wendy.clesi

We have also worked closely with the dietitians and physicians and have set up similar processes. The ASPEN criteria only accounts for severe and non-severe degrees of malnutrition. Because of this, we consider the entire clinical picture of the patient and use additional criteria to distinguish between mild, moderate and severe.

*ASPEN criteria
* BMI
*albumin
*history of poor dietary intake
* acute vs. chronic conditions
* conditions causing protracted nutritional loss such as malabsorption, draining abscess, etc.,
*hypermetabolic states such as sepsis, burns, extensive trauma, etc.
*history of alcohol abuse
*use of chronic medications with catabolic properties such as steroids, anti-tumor agents, etc.
*advanced age
*poor pigmentation, hair loss, or poor wound healing
*lymphocyte count
*cholesterol level (in absence of Statin therapy)
*treatment plan



-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, February 24, 2014 3:02 PM
To: Wendy Clesi
Subject: RE: [cdi_talk] Malnutrition

YES!
We have worked extensively with our Nutrition department in the past few years. In fact, one of our CDI's will be presenting a poster showcasing this work and I will be touching on this project in my presentation at the ACDIS conference.
Our dieticians use ASPEN criteria and do not use Albumin to substantiate dx since it is considered a poor indicator. They have no issue diagnosing Severe Protein Calorie Malnutrition and they use the verbiage we need for coding.
We are notified whenever they make a nutrition dx. We also let them know if we see a patient that we think is 'at risk' that has not been consulted. We have also set up a system where they are automatically notified when patients are admitted that were diagnosed with malnutrition in the past so that they can identify these patients and intervene more quickly.
We have also been involved in the building of their documentation templates so that we can make sure their documentation clearly establishes a dx with appropriate clinical indicators to prevent denials.

Let me know if you have more specific questions!

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, February 24, 2014 11:48 AM
To: Kathryn Good
Subject: [cdi_talk] Malnutrition

Has anyone worked on any projects with the dieticians in their facilities to make sure their documentation was assisting providers to make diagnosis that accurately reflect the patients nutritional status AND in a way that is recognized by code sets.

Have many hospitals moved to ASPEN criteria?

Many of our providers copy the words of dieticians. Dieticians frequently feel their hands are tied in being able to diagnose Severe malnutrition because the don't have an albumin- but the have a bmi 15, cancer, pressure ulcers and are started on TF or TPN.

It can be frustrating because they also say albumin is not a reliable indicator to assess nutritional status (yet it's what is missing to diagnose at times).

Has anyone had similar situations? and more importantly solutions?

Thanks for any input!

Ann Donnelly,RN,BSN,CCDS
ann.donnelly@sclhs.net
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annnd2009@gmail.com

If anyone has any template or duo gnostic check lists that they or
dietitians use that would be great!

I have the Aspen criteria.

Thanks
Ann
Ann.donnelly@sclhs.net

Sent from my iPhone

> On Feb 24, 2014, at 2:53 PM, CDI Talk wrote:
>
> We have also worked closely with the dietitians and physicians and have set up similar processes. The ASPEN criteria only accounts for severe and non-severe degrees of malnutrition. Because of this, we consider the entire clinical picture of the patient and use additional criteria to distinguish between mild, moderate and severe.
>
> *ASPEN criteria
> * BMI
> *albumin
> *history of poor dietary intake
> * acute vs. chronic conditions
> * conditions causing protracted nutritional loss such as malabsorption, draining abscess, etc.,
> *hypermetabolic states such as sepsis, burns, extensive trauma, etc.
> *history of alcohol abuse
> *use of chronic medications with catabolic properties such as steroids, anti-tumor agents, etc.
> *advanced age
> *poor pigmentation, hair loss, or poor wound healing
> *lymphocyte count
> *cholesterol level (in absence of Statin therapy)
> *treatment plan
>
>
>
> -----Original Message-----
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Monday, February 24, 2014 3:02 PM
> To: Wendy Clesi
> Subject: RE: [cdi_talk] Malnutrition
>
> YES!
> We have worked extensively with our Nutrition department in the past few years. In fact, one of our CDI's will be presenting a poster showcasing this work and I will be touching on this project in my presentation at the ACDIS conference.
> Our dieticians use ASPEN criteria and do not use Albumin to substantiate dx since it is considered a poor indicator. They have no issue diagnosing Severe Protein Calorie Malnutrition and they use the verbiage we need for coding.
> We are notified whenever they make a nutrition dx. We also let them know if we see a patient that we think is 'at risk' that has not been consulted. We have also set up a system where they are automatically notified when patients are admitted that were diagnosed with malnutrition in the past so that they can identify these patients and intervene more quickly.
> We have also been involved in the building of their documentation templates so that we can make sure their documentation clearly establishes a dx with appropriate clinical indicators to prevent denials.
>
> Let me know if you have more specific questions!
>
> 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
>
>
> -----Original Message-----
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Monday, February 24, 2014 11:48 AM
> To: Kathryn Good
> Subject: [cdi_talk] Malnutrition
>
> Has anyone worked on any projects with the dieticians in their facilities to make sure their documentation was assisting providers to make diagnosis that accurately reflect the patients nutritional status AND in a way that is recognized by code sets.
>
> Have many hospitals moved to ASPEN criteria?
>
> Many of our providers copy the words of dieticians. Dieticians frequently feel their hands are tied in being able to diagnose Severe malnutrition because the don't have an albumin- but the have a bmi 15, cancer, pressure ulcers and are started on TF or TPN.
>
> It can be frustrating because they also say albumin is not a reliable indicator to assess nutritional status (yet it's what is missing to diagnose at times).
>
> Has anyone had similar situations? and more importantly solutions?
>
> Thanks for any input!
>
> Ann Donnelly,RN,BSN,CCDS
> ann.donnelly@sclhs.net
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
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> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: wendy.clesi@drgreview.com If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-20286699.389b1234280e36dadf0b85386e189312@hcprotalk.com
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> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

lindenbm@bellsouth.net

At my previous employer, our dieticians used the SGA scoring system for malnutrition which provides a score or A, B, or C. We then created cheat sheets for our physicians explaining the SGA malnutrition scoring system that we sent it with the query. It worked really well.



At my current employer, our dieticians have just started using Aspen.



I have attached the SGA assessment tool.


Mary Lindenboom, RN, BSN, CCDS
Clinical Documentation Manager
Flagler Hospital
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 819-4254

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, February 24, 2014 4:53 PM
To: Mary Lindenboom
Subject: RE: [cdi_talk] Malnutrition



We have also worked closely with the dietitians and physicians and have set up similar processes. The ASPEN criteria only accounts for severe and non-severe degrees of malnutrition. Because of this, we consider the entire clinical picture of the patient and use additional criteria to distinguish between mild, moderate and severe.



*ASPEN criteria

* BMI

*albumin

*history of poor dietary intake

* acute vs. chronic conditions

* conditions causing protracted nutritional loss such as malabsorption, draining abscess, etc., *hypermetabolic states such as sepsis, burns, extensive trauma, etc.

*history of alcohol abuse

*use of chronic medications with catabolic properties such as steroids, anti-tumor agents, etc.

*advanced age

*poor pigmentation, hair loss, or poor wound healing *lymphocyte count *cholesterol level (in absence of Statin therapy) *treatment plan







-----Original Message-----

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]

Sent: Monday, February 24, 2014 3:02 PM

To: Wendy Clesi

Subject: RE: [cdi_talk] Malnutrition



YES!

We have worked extensively with our Nutrition department in the past few years. In fact, one of our CDI's will be presenting a poster showcasing this work and I will be touching on this project in my presentation at the ACDIS conference.

Our dieticians use ASPEN criteria and do not use Albumin to substantiate dx since it is considered a poor indicator. They have no issue diagnosing Severe Protein Calorie Malnutrition and they use the verbiage we need for coding.

We are notified whenever they make a nutrition dx. We also let them know if we see a patient that we think is 'at risk' that has not been consulted. We have also set up a system where they are automatically notified when patients are admitted that were diagnosed with malnutrition in the past so that they can identify these patients and intervene more quickly.

We have also been involved in the building of their documentation templates so that we can make sure their documentation clearly establishes a dx with appropriate clinical indicators to prevent denials.



Let me know if you have more specific questions!



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





-----Original Message-----

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]

Sent: Monday, February 24, 2014 11:48 AM

To: Kathryn Good

Subject: [cdi_talk] Malnutrition



Has anyone worked on any projects with the dieticians in their facilities to make sure their documentation was assisting providers to make diagnosis that accurately reflect the patients nutritional status AND in a way that is recognized by code sets.



Have many hospitals moved to ASPEN criteria?



Many of our providers copy the words of dieticians. Dieticians frequently feel their hands are tied in being able to diagnose Severe malnutrition because the don't have an albumin- but the have a bmi 15, cancer, pressure ulcers and are started on TF or TPN.



It can be frustrating because they also say albumin is not a reliable indicator to assess nutritional status (yet it's what is missing to diagnose at times).



Has anyone had similar situations? and more importantly solutions?



Thanks for any input!



Ann Donnelly,RN,BSN,CCDS

ann.donnelly@sclhs.net

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jlightfoot@marshallmedical.org

We've also worked closely with our dieticians and hospitalists and use a similar communication process back and forth. Since we have a hybrid record, when our dieticians diagnose a pt with malnutrition, they print their assessment and place it in the physician progress notes section for review and hopefully confirmation by the physician in their following progress notes. It's been a successful process with less queries needed for malnutrition. Our hospitalists as a group have responded positively to the ASPEN criteria versus BMI, albumin and prealbumin.


Jillian Lightfoot, RN
Clinical Documentation Team
Marshall Medical Center
Placerville, CA 95667
(530) 626-2770 Ext. 6203
jlightfoot@marshallmedical.org




-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, February 24, 2014 1:02 PM
To: Lightfoot, Jillian
Subject: RE: [cdi_talk] Malnutrition

YES!
We have worked extensively with our Nutrition department in the past few years. In fact, one of our CDI's will be presenting a poster showcasing this work and I will be touching on this project in my presentation at the ACDIS conference.
Our dieticians use ASPEN criteria and do not use Albumin to substantiate dx since it is considered a poor indicator. They have no issue diagnosing Severe Protein Calorie Malnutrition and they use the verbiage we need for coding.
We are notified whenever they make a nutrition dx. We also let them know if we see a patient that we think is 'at risk' that has not been consulted. We have also set up a system where they are automatically notified when patients are admitted that were diagnosed with malnutrition in the past so that they can identify these patients and intervene more quickly.
We have also been involved in the building of their documentation templates so that we can make sure their documentation clearly establishes a dx with appropriate clinical indicators to prevent denials.

Let me know if you have more specific questions!

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, February 24, 2014 11:48 AM
To: Kathryn Good
Subject: [cdi_talk] Malnutrition

Has anyone worked on any projects with the dieticians in their facilities to make sure their documentation was assisting providers to make diagnosis that accurately reflect the patients nutritional status AND in a way that is recognized by code sets.

Have many hospitals moved to ASPEN criteria?

Many of our providers copy the words of dieticians. Dieticians frequently feel their hands are tied in being able to diagnose Severe malnutrition because the don't have an albumin- but the have a bmi 15, cancer, pressure ulcers and are started on TF or TPN.

It can be frustrating because they also say albumin is not a reliable indicator to assess nutritional status (yet it's what is missing to diagnose at times).

Has anyone had similar situations? and more importantly solutions?

Thanks for any input!

Ann Donnelly,RN,BSN,CCDS
ann.donnelly@sclhs.net
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katysuegood@gmail.com

Aspen Criteria? Here is our simplified version.

But really, we rely on nutrition to make these diagnosis and really just make sure that the MD documents the nutritionists dx (assuming they agree, of course).

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 28, 2014 10:53 AM
To: Kathryn Good
Subject: [cdi_talk] malnutrition

I am looking for some assistance in developing guidelines for malnutrition. If anyone has any they use or have developed and would like to share I would greatly appreciate it.

Thanks to all in advance.

Tracy
tpeyton@brmc.com
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Unknown

Katy:

Are you putting that table in Epic? If so, where? We use the coding query section of Epic for our queries and are having a hard time putting tables in that area. Any suggestions would be greatly appreciated!

Linda Haynes, RHIT, CCDS
Manager, CDI
Legacy Health
lhaynes@lhs.org

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 28, 2014 12:59 PM
To: Haynes, Linda :CO Care Management
Subject: RE: [cdi_talk] malnutrition

Aspen Criteria? Here is our simplified version.

But really, we rely on nutrition to make these diagnosis and really just make sure that the MD documents the nutritionists dx (assuming they agree, of course).

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 28, 2014 10:53 AM
To: Kathryn Good
Subject: [cdi_talk] malnutrition

I am looking for some assistance in developing guidelines for malnutrition. If anyone has any they use or have developed and would like to share I would greatly appreciate it.

Thanks to all in advance.

Tracy
tpeyton@brmc.com
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katysuegood@gmail.com

Linda,
No, we use Cerner but this is not included in our query. Our process is a bit different because we rely heavily on nutrition to provide specificity. The Aspen guidelines I attached earlier have been provided to the MD's and are in the 'documentation binders' that are in dictation rooms but primarily nutritionists are using them. They make the diagnosis based on ASPEN criteria and then CDI simply ensures that this is pulled through into the physician notes. If we see someone that we are concerned about that our nutritionist have not been consulted on yet, we contact nutrition to see if they think they need to be involved.

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 28, 2014 8:00 PM
To: Kathryn Good
Subject: RE: [cdi_talk] malnutrition

Katy:

Are you putting that table in Epic? If so, where? We use the coding query section of Epic for our queries and are having a hard time putting tables in that area. Any suggestions would be greatly appreciated!

Linda Haynes, RHIT, CCDS
Manager, CDI
Legacy Health
lhaynes@lhs.org

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 28, 2014 12:59 PM
To: Haynes, Linda :CO Care Management
Subject: RE: [cdi_talk] malnutrition

Aspen Criteria? Here is our simplified version.

But really, we rely on nutrition to make these diagnosis and really just make sure that the MD documents the nutritionists dx (assuming they agree, of course).

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


-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 28, 2014 10:53 AM
To: Kathryn Good
Subject: [cdi_talk] malnutrition

I am looking for some assistance in developing guidelines for malnutrition. If anyone has any they use or have developed and would like to share I would greatly appreciate it.

Thanks to all in advance.

Tracy
tpeyton@brmc.com
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martin.conroy

Having been a Director of Coding for a Health System for a long time, what you have written is maddening. Stop talking to the coders about the issue and direct your attention to Coding leadership. Ask to see the coding policy for SPCM. I would have leadership from nutrition included to be sure the policy meets clinical criteria used by your facility. Depending on what you uncover you can: help to write a policy all can agree with, or ask why there is not consistent application of the rules in the policy by the coding team. I would never accept inconsistent application of coding guidelines by my team. Keeping in mind every case is unique and must be viewed based on it's unique documentation.

This is not your problem it sounds like it is a Coding leadership issue.

Marty
Temple Health