"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
I worked with the dieticians here to finalize the guidelines I put in the query. The information came from the different references I found in the forms and tools library on the ACDIS site. The dieticians here are not fans of using the labs to determine protein calorie malnutrition but agreed with what I came up with as a guide. They are the experts after all. As a rule, I don't see this much and if I do I wait for the dietary consult to be completed before I query so I can refer their findings to the provider.
Of course it's still the providers call.
Robert
Robert S. Hodges, BSN, MSN, RN Clinical Documentation Improvement Specialist Aleda E. Lutz VAMC Mail Code 136 1500 Weiss Street Saginaw MI 48602
Thanks. I like your query format as ours has a lot of information on it which I think the doctors sometimes won't even bother to look at. We have adopted the University of Pittsburgh Medical Center criteria with the blessing of our dietician and physician advisor.
Be careful, a BMI < 19 is not always malnutrition at all, let alone severe malnutrition. Some people are thin and still healthy. For severe malnutrition also look at albumins
I found this on justcoding this morning. We have had a lot of discussion between the coders and CDI's about this. I thought it was helpful. I am also including the graph we use on our queries
"Q&A: Coding for protein malnutrition NOVEMBER 10, 2010 — QUESTION: Our physician provided an illegible diagnosis of malnutrition, and when we queried him regarding the specific type of malnutrition, he provided protein malnutrition. The ICD-9-CM Manual directs us to assign ICD-9-CM code 260; however, a consultant told us this is incorrect because this code represents Kwashiorkor. In your opinion, what should we do?
ANSWER: Based on Coding Clinic 3rd quarter, 2009, I would report ICD-9-CM code 263.9 (unspecified protein-calorie malnutrition) if you cannot obtain the information that would classify the malnutrition as mild or moderate.
The Coding Clinic reference previously mentioned states coders should not report ICD-9-CM code 260 when the provider does not specifically document Kwashiorkor. Coding Clinic also states the following: Kwashiorkor syndrome is a condition that is caused by severe protein deficiency that is usually seen in some underdeveloped areas in Africa and Central America; however it is extremely rare in the United States. The National Center for Health Statistics (NCHS) is considering a proposal to revise the index entries under mild and moderate protein malnutrition in order to provide clearer direction to the coder. Also, note that for 2011, the following revision to the Alphabetic index incorporated the word protein as a non-essential modifier: Malnutrition Mild (protein) – 263.1 Moderate (protein) – 263.0 In addition, it is of note that in the 2011 ICD-10-CM Manual, the Alphabetic index somewhat remedies this issue but also presents additional concerns: Malnutrition Protein – E46 (unspecified protein-calorie malnutrition) Severe (protein-energy) With Kwashiorkor (and marasmus) – E42 (Marasmic Kwashiorkor) I find it interesting that there is also code E40 (Kwashiorkor), which the Alphabetic Index does not default to except under Malnutrition, malignant or Kwashiorkor as a main term. Editor’s note: This Q&A was adapted from one published in the November issue of Briefings on Coding Compliance Strategies. Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding at HCPro Inc., in Marblehead, MA, answered this question. This answer was provided based on limited information that was submitted to our publication. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment. "
Comments
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
Where did you get your criteria for malnutrition from?
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
Waterbury Hospital
203 573 7647
Of course it's still the providers call.
Robert
Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
Waterbury Hospital
203 573 7647
Robert
Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
I found this on justcoding this morning. We have had a lot of discussion between the coders and CDI's about this. I thought it was helpful. I am also including the graph we use on our queries
"Q&A: Coding for protein malnutrition
NOVEMBER 10, 2010 —
QUESTION: Our physician provided an illegible diagnosis of malnutrition, and when we queried him regarding the specific type of malnutrition, he provided protein malnutrition. The ICD-9-CM Manual directs us to assign ICD-9-CM code 260; however, a consultant told us this is incorrect because this code represents Kwashiorkor. In your opinion, what should we do?
ANSWER: Based on Coding Clinic 3rd quarter, 2009, I would report ICD-9-CM code 263.9 (unspecified protein-calorie malnutrition) if you cannot obtain the information that would classify the malnutrition as mild or moderate.
The Coding Clinic reference previously mentioned states coders should not report ICD-9-CM code 260 when the provider does not specifically document Kwashiorkor. Coding Clinic also states the following:
Kwashiorkor syndrome is a condition that is caused by severe protein deficiency that is usually seen in some underdeveloped areas in Africa and Central America; however it is extremely rare in the United States. The National Center for Health Statistics (NCHS) is considering a proposal to revise the index entries under mild and moderate protein malnutrition in order to provide clearer direction to the coder.
Also, note that for 2011, the following revision to the Alphabetic index incorporated the word protein as a non-essential modifier:
Malnutrition
Mild (protein) – 263.1
Moderate (protein) – 263.0
In addition, it is of note that in the 2011 ICD-10-CM Manual, the Alphabetic index somewhat remedies this issue but also presents additional concerns:
Malnutrition
Protein – E46 (unspecified protein-calorie malnutrition)
Severe (protein-energy)
With Kwashiorkor (and marasmus) – E42 (Marasmic Kwashiorkor)
I find it interesting that there is also code E40 (Kwashiorkor), which the Alphabetic Index does not default to except under Malnutrition, malignant or Kwashiorkor as a main term.
Editor’s note: This Q&A was adapted from one published in the November issue of Briefings on Coding Compliance Strategies. Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding at HCPro Inc., in Marblehead, MA, answered this question. This answer was provided based on limited information that was submitted to our publication. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment. "