To determine and identify whether patients are at risk of malnutrition, healthcare physicians and medical coders must have an efficient way of communicating all patient documentation and treatments to one another. In our most recent Webinar Malnutrition At-A-Glance Coding and Denials, Marie Thomas, ECLAT Senior Director, Coding and HIM Operations, Evelyn Santos, ECLAT Coding and Audit Specialist, and Guest Contributor, Clinical Nutrition Manager (RDN) at Health Central Hospital, and Arelys Villafane helped listeners explore malnutrition clinical indicators and the many ways medical coders can increase accuracy, tools to use to properly identify malnutrition, and how to avoid the denials that commonly occur.
ECLAT Health Solutions cares to provide detail-oriented clinical documentation improvement services at your convenience to allow you and your team to thrive at providing quality healthcare experiences. Here’s an overview of what was discussed between Marie and Evelyn, in our latest Experience the Brilliance Webinar: Malnutrition At-A-Glance Coding and Denials.
The Clinical Perspective
With Arelys Villafane’s expert contributions, Marie spoke in length about how previously in the clinical field, malnutrition was “once thought of as not having adequate sustenance for consumption to maintain proper health. For instance, in third world countries.” When in fact, malnutrition is an acute, subacute, or chronic state of nutrition in which a combination of varying degrees of overnutrition or undernutrition with or without inflammatory activity has led to a change in body composition and diminished function. While it’s also a common problem in hospital patients that often goes unrecognized, undiagnosed, and untreated, research has shown that malnutrition occurs in 30-55% of hospital patients and leads to significant negative outcomes.
Marie explained to the live Malnutrition At-A-Glance Coding and Denials attendees that research also shows us that early nutrition interventions can improve health outcomes, mobility, mortality, and reduce the length of stay in hospital patients. One proactive way to catch malnutrition indicators is by screening patients using a validated screening tool such as the Malnutrition Screening Tool (MST) upon admission. This helps improve the early identification of patients at risk of malnutrition to facilitate early nutrition interventions.
A malnutrition project had taken place to investigate the accuracy of malnutrition documentation and coding to calculate both capture and missed reimbursement. Arelys’ notes state:
- As a result, an average of 56% of patients identified as malnourished by the dietitian was coded with a malnutrition diagnosis. Missed opportunities for diagnosing at-risk patients occurred due to a lack of physician documentation.
- RDN driven reimbursement for FY 2018 = $280,774.63. Malnutrition diagnosis was the only CC or MCC that increased reimbursement for a specific DRG and not including insurance denials.
- Missed reimbursement opportunities for FY 2018 = 238, 239.17. This represents patients w/o a malnutrition diagnosis code that had the potential to be the only driven of increased reimbursement.
The Medical Coding Perspective
When it comes to coding at-risk malnutrition patients, Marie stated that “coders are unable to code from anyone other than the physician or provider.” To make this information more widely available to coders, she recommended that the patient must be properly screened and identified as an at-risk patient through a Nutrition Assessment Form meeting at least two or more of the criteria. Once the patient has been identified, the documentation goes to the CDI team, in which the CDI team works with the physician to solidify a complete diagnosis. After the documentation has been evaluated by the CDI professionals and the physician, it goes right back to the chart and is saved in the patient’s records.
As the webinar progressed, Evelyn would pose frequently asked questions like “in order to understand clinical indicators for malnutrition, what guidelines should hospitals and staff follow?” Marie then discussed malnutrition indicator tips, when and how to appropriately query a physician, and why following strict criteria is important in the documentation and coding malnutrition. To learn more about proper documentation and coding malnutrition, watch our Webinar replay and download the handout for ECLAT's webinar Malnutrition At-A-Glance Coding and Denials today!
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