Q&A: Assessing malnutrition diagnoses

December 4, 2014

CDI Strategies - Volume 8, Issue 25

Q: If a is patient admitted with malnutrition and the physician documented the patient to be malnourished from mild to severe, would the CDI team use DRG 641, Severe Malnutrition as a working DRG, or should we query the physician to clarify the severity or type of malnutrition?

A: DRG 641, Severe Malnutrition would require use of ICD-9-CM code 261, Nutritional Marasmus, which is a high-risk diagnosis vulnerable to denial. The same is true for ICD-9-CM code 260, Kwashiorkor. These conditions describe a very specific type of severe malnutrition typically found in third-world countries that doesn’t typically exist in the U.S.

Even if it wasn’t a vulnerable diagnosis the difference between mild and severe malnutrition constitutes the difference between a CC and an MCC designation. So first, look to see what clinical indicators and treatment support were documented in the record. In my opinion, the treatment is often what separates mild nutrition from severe malnutrition. If the clinical indicators and treatment support severe protein calorie malnutrition (ICD-9-CM code 262), I would query the provider to clarify their documentation as to the type.

The following are some additional articles that might help shed a little more light on these conditions and their relative controversy over the years:

Editor’s Note: Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, CDI Education Director for HCPro Inc., answered this question which was originally published on the ACDIS Blog. Contact her at cericson@hcpro.com. For information regarding CDI Boot Camps offered by HCPro visit www.hcprobootcamps.com/courses/10040/overview.

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