Shortfalls in malnutrition coding : a mandate for action

Agarwal, Ekta, Ferguson, Maree, Banks, Merrilyn, Bauer, Judith, Capra, Sandra, & Isenring, Elisabeth (2013) Shortfalls in malnutrition coding : a mandate for action. Nutrition and Dietetics, 70(s1), p. 4.

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The International Classification of Diseases, Version 10, Australian modification (ICD-10- AM) is commonly used to classify diseases in hospital patients. ICD-10-AM defines malnutrition as “BMI < 18.5 kg/m2 or unintentional weight loss of ≥ 5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting”. The Australasian Nutrition Care Day Survey (ANCDS) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from Australian and New Zealand hospitals1. This study determined if malnourished participants were assigned malnutritionrelated codes as per ICD-10-AM. The ANCDS recruited acute care patients from 56 hospitals. Hospital-based dietitians evaluated participants’ nutritional status using BMI and Subjective Global Assessment (SGA). In keeping with the ICD-10-AM definition, malnutrition was defined as BMI <18.5kg/m2, SGA-B (moderately malnourished) or SGA-C (severely malnourished). After three months, in this prospective cohort study, hospitals’ health information/medical records department provided coding results for malnourished participants. Although malnutrition was prevalent in 32% (n= 993) of the cohort (N= 3122), a significantly small number were coded for malnutrition (n= 162, 16%, p<0.001). In 21 hospitals, none of the malnourished participants were coded. This is the largest study to provide a snapshot of malnutrition-coding in Australian and New Zealand hospitals. Findings highlight gaps in malnutrition documentation and/or subsequent coding, which could potentially result in significant loss of casemix-related revenue for hospitals. Dietitians must lead the way in developing structured processes for malnutrition identification, documentation and coding.

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ID Code: 63113
Item Type: Journal Article
Refereed: Yes
Additional Information: Special Issue: Abstracts of the Dietitians Association of Australia 30th National Conference, 23–25 May 2013, National Convention Centre, Canberra, Australia.
Mrs Agarwal is the winner of Research in Practice Award in this conference.
Additional URLs:
Keywords: malnutrition, coding, casemix, reimbursement
DOI: 10.1111/1747-0080.12034
ISSN: 1747-0080
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NUTRITION AND DIETETICS (111100) > Nutrition and Dietetics not elsewhere classified (111199)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Schools > School of Exercise & Nutrition Sciences
Copyright Owner: Copyright 2013 Dietitians Association of Australia
Deposited On: 03 Oct 2013 22:47
Last Modified: 31 Oct 2016 14:22

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