We work closely with our dieticians for malnutrition diagnoses. We use Aspen criteria, some of which can be found in the CDI Pocket Guide. I immediately look at the weight/length z-score and weight for age z-score (children <2 years) or BMI z-score and weight for age z-score (children >2 years). Generally z-score < -1.00 may be mild malnutrition, <-2 may be moderate malnutrition, and <-3 may be severe malnutrition. If CDS has suspicions based on z-scores/physical exam or child has a previous diagnosis of malnutrition (any degree), we let the dietician know. The dieticians have a procedure for assessing, documenting degree, notifying MD, and sending an order to the MD with the specified degree of malnutrition. If any part of the RD's process "breaks down", CDS clarifies using the clinical indicators, risk factors and treatment that are appropriate.
Hi at CHOP, we teamed up with our dietician dept to come up with a pathway, using the APSEN guideline. We use clinical indicators, and if the doc says malnutrition we refer back to the dietician's note that has the specificity documented. Although, our coders can use the dietician's note for specificity, as long as the doc says malnutrition, we still ask for the doctors to document the specificity.
We use the physician documentation. If physician documents "malnutrition", coders will code unspecified regardless of what RD assessment documents or will send a post-discharge query to the MD for degree.
Wow, there seems to be so much variance here. As a new CDI, this makes me nervous.
Here, the RD suggests malnutrition and severity to the provider, based on Z-scores. I am copied on that email. Then the provider chooses whether or not to document the diagnosis. They almost always do.
Comments
Jackie Touch
Use the dietician's nutritional diagnoses to query the Provider for the diagnosis.
Hi at CHOP, we teamed up with our dietician dept to come up with a pathway, using the APSEN guideline. We use clinical indicators, and if the doc says malnutrition we refer back to the dietician's note that has the specificity documented. Although, our coders can use the dietician's note for specificity, as long as the doc says malnutrition, we still ask for the doctors to document the specificity.
Steph
Jackie Touch
Wow, there seems to be so much variance here. As a new CDI, this makes me nervous.
Here, the RD suggests malnutrition and severity to the provider, based on Z-scores. I am copied on that email. Then the provider chooses whether or not to document the diagnosis. They almost always do.