Marty’s Corner: Identifying and Treating Malnutrition (and Coding It, Too!)
Malnutrition is a hot topic these days as more and more attention is focused on its underreporting among hospitalized patients. While we used to think of malnutrition in terms of populations of Third World countries, we’ve more recently come to realize its presence in patients when they’re admitted to, treated in, or even discharged from our own healthcare institutions. It’s such an important issue that the House of Delegates of the Academy of Nutrition and Dietetics considers it a “mega-issue” and will be discussing it at its Fall meeting in Nashville on October 2.
It’s More Prevalent than You Think
The incidence of malnutrition in hospitals among both adult and pediatric patients ranges anywhere from 30-50%1, with some reports of an even more extensive range. Among those patients for whom malnutrition is identified, surprisingly only around three percent are actually discharged with it as a diagnosis.
Benefitting the Hospital as Well as the Patient
Besides the obvious reasons to identify and treat malnutrition – such as ensuring that a patient is physically able to withstand surgery, has an optimally-functioning immune system, and to prevent or minimize muscle wasting -- another is to capture otherwise unrealized revenues. When malnutrition is identified, included as a diagnosis (and therefore coded properly), a hospital can increase its reimbursement by thousands of dollars per patient. One hospital in Michigan achieved nearly $800,000 in additional revenue in one year when dietitians, nurses, and physicians worked together to better identify and document the existence of malnutrition.2 This reimbursement has been available to hospitals since October, 2012 when the Centers for Medicare and Medicaid Services changed codes for mild and moderate malnutrition to a “complication/co-morbidity”, thereby making those diagnoses eligible for payment.2 Nevertheless, many hospitals have yet to adopt practices to ensure that malnutrition is identified and coded, citing factors such as staff resources or lack of expertise in proper completion of nutrition assessments, which is where most malnutrition is first identified.
Software Can be a Valuable Tool
Foodservice and nutrition care management software can provide important tools for the dietitian and dietetic technician to help identify when malnutrition exists. Certain reasons for admission can send up a red flag for nutrition staff to be on the lookout for the presence of malnutrition. Height and weight (both usual and current) are typically recorded in the electronic health record and transmitted via interface to these software systems, where Body Mass Index is calculated and ongoing weight and weight changes are recorded. A patient’s intake can be recorded and analyzed for any number of desired nutrients. Patients on special diets (such as texture-modified and with thickened liquids) or needing adaptive equipment may also be at increased risk and can be easily identified by software systems. Having the tools to better identify malnutrition can assist in its proper coding, helping not only to treat the patient with optimal nutrition therapy, but also to increase much-needed hospital revenue.
- Field LB, Hand RK. Differentiating malnutrition screening and assessment: a Nutrition Care Process perspective. J Acad Nutr Diet 2015; 115(5): 824-828.
- http://www.eatrightpro.org/resource/leadership/house-of-delegates/about-hod-meetings/fall-meeting-materials, accessed August 11, 2015.
Article by: Marty Yadrick, MBI, MS, RDN, FAND - Director of Nutrition Informatics and former President of the Academy of Nutrition and Dietetics; Fusion, 2nd Quarter, 2015