By Linnea Archibald

The diagnosis of malnutrition has long been in the sights of the Office of Inspector General (OIG) for audits and denials. In fact, just as recently as December 2017, the OIG found that of 2,145 inpatient claims from 2006-2014 at 25 providers, all but one incorrectly included the diagnosis code for kwashiorkor. This resulted in overpayments in excess of $6 million.

Because of the high level of scrutiny applied to these claims, CDI professionals focused on accurately capturing patients’ nutritional status—and that is no easy task. While a dietitian may be consulted, and may document a body mass index (BMI) far under the normal range, physicians often miss the diagnosis in their own documentation/progress notes, or document in such a way that leads to the coder assigning the wrong type of malnutrition , leading, in turn, to a denial down the road.

Since this is such a large, ever-present issue for CDI professionals, ACDIS has assembled a number of resources to help you make sense of it all and ensure your records are complete, clear, accurate, and audit proof.