Journal excerpt: Organizational criteria for malnutrition

An important step toward preventing malnutrition denials on the front end is developing organizational policies and diagnostic criteria. This process should involve multiple departments, and the end product should represent the organization’s consensus statement on the condition’s diagnostic criteria, which can be used to appeal denials and anchor clinical validation queries.

For tackling malnutrition, Vaughn Matacale, MD, CCDS, director of the CDI advisor program at Vidant Health in Greenville, North Carolina, suggests a facility adopt ASPEN/AND malnutrition clinical guidelines for their diagnostic criteria. “The guidelines are set forth by those entities, who are really the authorities in the industry as far as malnutrition diagnostic criteria goes,” he says.

While it may be tempting to write your own guidelines, Matacale strongly suggests against it. Because there is already an industry standard available that’s been peer-reviewed and accepted by the broader medical community, this should be the standard facilities use. “These tools are already available to you,” he says. “The majority of hospitals that have been surveyed by AND and ASPEN have said these are the predominant criteria being used, so that shows you what the industry standard is.”

The criteria for malnutrition, however, is somewhat in a state of flux because of the newly created GLIM guidelines, Haik adds.

“I’d adhere to the ASPEN criteria for now, but at least peer over the counter at GLIM too as it’s very possible that will become the more relevant criteria at some point,” he says. Additionally, at least one of the RACs is using GLIM even though the AND has not fully field tested those criteria. “GLIM uses international standards for criteria, and the problem with that is we’re very different in the United States than other countries. We are more likely to have people who are obese but also malnourished, something not as common in other countries.”

Editor’s note: Read this full CDI Journal article here.