Q&A: GLIM as malnutrition criteria
Q: My organization has received three denials for the diagnosis of severe calorie malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. All three denials came from the same small insurance company. We don’t use GLIM criteria at our organization currently. Should we switch criteria sets to match what payers are using to validate claims?
A: Let’s start by looking at the background and use of the GLIM criteria. On March 18, 2019, a message from the president of the Academy of Nutrition and Dietetics stated,
The GLIM approach includes a set of readily available criteria that can be used in combination with existing diagnostic approaches including the Academy/ASPEN [American Society for Parenteral and Enteral Nutrition] malnutrition consensus characteristics. The GLIM approach does not replace the Academy/ASPEN methodology at this time but may be used in conjunction with it. Efforts are underway to conduct validation studies of the GLIM construct.
On July 1, 2019, a follow-up ASPEN clarifying document was released that stated,
GLIM is fully congruent with established approaches like the Academy/ASPEN criteria and Subjective Global Assessment (SGA). They share multiple variables and are not inconsistent. GLIM, Academy/ASPEN criteria or SGA may be used independently to diagnosis malnutrition. Both the Academy/ASPEN and GLIM approaches are undergoing validation testing. Building upon the GLIM approach, it may ultimately be possible to derive a minimum dataset of key core criteria that will provide a framework to serve a broad range of practitioners in a variety of clinical nutrition settings.
While GLIM criteria has yet to receive much adoption from dietitian professional organizations, it is being used heavily by Recovery Audit Contractors. It may be helpful to work with your facility’s physician advisors, compliance department, and dietitians on the topic to develop an internal organizationwide definition for all malnutrition diagnoses.
Generally speaking, ASPEN still remains the most accepted criteria set. Because auditors are using GLIM, however, you may way to look at ways of building it into your organization’s clinical terminology and criteria.
If your registered dieticians and other providers do not agree on the use of GLIM, however, the next best step would be to develop your organizational criteria set and then work with your payer contracting and compliance departments to make it an official policy internally and with third party payers. At the end of the day, the clinicians treating the patient make the call on the final diagnosis and they’re criteria set should not be dictated by an outside payer.
Editor’s note: This question and answer were adapted from a thread on the ACDIS Forum. To learn more about participating on the Forum, click here. For more information about documentation and denials management for severe malnutrition, click here.