Malnutrition criteria

Snook@fmchealth.org

What is the latest on the malnutrition criteria? Our RAC auditor has two payers using WHO criteria which with a BMI of < 16 would mean no one could meet the criteria. Our organization's criteria is solid with our research. One of the criteria is BMI < 19. We also have certain numerical criteria for weight loss, po intake and muscle wasting and subcutaneous fat loss based on the Academy for Nutrition and Dietetics etc. Our criteria are based on research and come from our Registered Dieticians. WHO is for third world countries and we are not a third world country. If anyone here had a BMI of < 16 they would be on Palliative near death. I did understand that they will be using WHO criteria when ICD 10 rolls out. I think they want to make it impossible for anyone to be malnourished. Help!

Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443



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evanspx@sutterhealth.org

I don't have anything technical regarding malnutrition that I can offer, but can only say that it seems many RD Teams now use Aspen. On a more general note, I am also frustrated that various 3rd parties will deny a code representing a condition staying the condition in question 'did not meet criteria'. However, our team uses criteria universally accepted by our physicians, such as KDIGO, Surviving Sepsis, and so forth. I find it frustrating that the auditors will deny our claims when the conditions coded are:

1. Documented
2. Meet Current Clinical Criteria accepted in the medical filed

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

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421

evanspx@sutterhealth.org

katysuegood@gmail.com

I agree Paul. Our dieticians use ASPEN criteria. Our MD's may determine a patient to be malnourished without the patient meeting ASPEN though. As long as they are using some sort of established criteria this dx can be defended. That being said, you may not always win....

I also agree with Robert in his assessment of the utility of BMI. A low BMI is only one piece of the overall clinical picture of a patient. Patients may have a very low BMI and not be malnourished and they can also be obese and severely malnourished. For a low BMI alone we may query for underweight if applicable but we don't query for malnutrition. In fact, we do not query for malnutrition at all without a dieticians assessment. If we see a patient with clinical indicators of malnutrition without a dietary consult we contact nutrition directly so that they can effectively assess and treat the patient. Once they have assessed the patient we use their assessment to drive the query.

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

gwojo

Hi Mary, what are you using now, ASPEN criteria?
Fran~

Snook@fmchealth.org

See my attached query. It is not Aspen. Our dieticians approved this query. Where would I get the Aspen criteria?
Mary L. Snook RN-BC

Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443



of denials. Some payers use WHO criteria. Any ideas?

Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443

gwojo

I Mary, I stepped away. Glad you got the info you requested.
Fran~