News: 64% malnutrition cases didn’t have the condition coded, implications for LOS, study finds

An inpatient study published in the Journal of the Academy of Nutrition and Dietetics analyzed a community hospital’s monthly reports for malnourished patients admitted between March 2015 and June 2017. During this time, registered dietician nutritionists identified 1,817 records for malnourished adult patients. Of these patients, 1,171 (64.4%) of them were not coded for malnutrition, Revenue Cycle Advisor reported.

To examine the effect of malnutrition coding on expected geometric length of stay (GMLOS), researchers collected clinical data from the hospital where patients are screened for nutritional risk within 24 hours of admission. Reports on malnourished patients are generated monthly by the hospital’s financial analysts and include admission and discharge dates, assigned MS-DRGs, CCs or MCCs, and their associated ICD-10-CM codes.  

The Medicare expected GMLOS based on assigned MS-DRGs was 3.5 days. However, the average length of stay for this group was 5.3 days. Researchers estimate that if malnutrition had been coded appropriately, the expected GMLOS would have been 5.2 days, which is much closer to the actual average length of stay for this subset of patients.

Hospitals typically don’t receive additional reimbursement for inpatient stays that exceed the expected length of stay, as determined by the MS-DRG assignment, so these cases were likely under-reimbursed.

According to the researchers’ findings, of the malnourished patients who were not coded for malnutrition, 475 or 40.6% of them would have benefited from proper coding to change the MS-DRG, RW, and expected GMLOS.

Editor’s note: To read Revenue Cycle Advisor’s coverage of this story, click here. To read more about malnutrition documentation, click here.