Not long ago, a coder’s job just required them to translate a physician’s diagnosis into an ICD-10 code. The codes were then submitted for reimbursement and statistical purposes. Over the past few years coding has evolved into so much more. Now coders are required to pick up on clinical indicators that don’t seem to fit in with the patient’s story and sometimes even challenge a physician’s judgment to get a claim paid. A perfect example of this is the diagnosis of malnutrition.
A recent OIG Workplan focused on the malnutrition codes E41, nutritional marasmus, and E43, unspecified severe protein-calorie malnutrition. The final report had a few surprises. Not only did the OIG check to see if these codes were reported correctly based on the Official Coding Guidelines, but the OIG took it a step further and determined if the documentation and treatment clinically supported a diagnosis of severe malnutrition.
The results were eye-opening, to say the least. The OIG determined that hospitals correctly billed Medicare for severe malnutrition diagnosis codes only 27 times out of 200 cases they reviewed. That is an abysmal accuracy rate of about 14%, quite a difference from the 95% accuracy rate we all strive to meet or exceed on a typical coding audit. What does that mean in terms of reimbursement? The OIG estimates over $1 BILLION was overpaid to facilities over two years.
During our malnutrition webinar, we’ll discuss the OIG Work Plan, including the clinical criteria used to determine the validity of the malnutrition codes. We’ll also offer suggestions that facilities can immediately implement to help tighten up the documentation necessary to support the diagnosis of severe malnutrition. This is one webinar your coders, dieticians, and CDI team need to see!
Terri Reid, CCS, CCS-P, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer
Senior Coding Quality Auditor
Terri comes to Haugen Group with 20+ years of health information management experience in coding, auditing, and education. She began her career coding emergency room records and wound care records where she helped develop coding and E/M protocols and met with the providers to help them improve their documentation. Terri transitioned to an auditing role when she realized how much she enjoyed sharing her coding knowledge and experiences with other coders to help improve their skills and confidence. Terri brings her expertise in coding and auditing to the Haugen Consulting Group, having worked in previous roles leading and performing inpatient and outpatient coding audits. She is passionate about learning new medical technology and how the disease process affects illnesses.