of 1.6407. The hospital has a base rate of $6,000, so it will expect
a payment of $9,844.20.
If, however, the secondary diagnosis was documented as
protein-calorie malnutrition (ICD-9-CM code 263.9) instead of
protein malnutrition (ICD-9-CM code 260), then MS-DRG 683
Renal Failure with CC, with a relative weight of 1.0243, would be
assigned, and the expected reimbursement would be $6,145.80.
vider, but the increased accuracy is worth the effort.
x The format of the diagnosis list should encourage a review
of all possible selections. The first-listed diagnosis or con-
dition is often the one most selected by providers. Facili-
ties should provide physicians training on selecting the
correct diagnosis from the list.
x Facilities should validate the mapping of the diagnostic
terms on the section list to ensure they link to the correct
ICD-9-CM code.
Ensuring Accurate Malnutrition Coding
Assignment of code 260 has gained increasing attention from
auditors and the media. A February 2011 article in the San Francisco Chronicle flagged hospitals that frequently assigned code
260 for inpatients, highlighting how the code affects payment
for Medicare Part A patients. 3
In order to ensure accurate malnutrition coding, facilities
should review electronic tools that automate diagnosis selec-
tion. Several aspects of electronic checklists or pick lists need
consideration, including the following:
x The programming of diagnosis lists should be reviewed by
a coding professional who understands the classification
system.
x The diagnosis list should include all choices of a particular
condition (e.g., all entries under the main term malnutri-
tion). This may require an additional “click” by the pro-
Other steps to take to validate the accuracy of ICD-9-CM code
260 and to identify any potential risk include the following:
Hospitals should develop and adopt clinician documentation requirements and clinical criteria for the various types
of malnutrition. This should be done with input from the medical staff, registered dieticians, coding professionals, and clinical
documentation specialists using reliable resources.
Facilities should run a data report from October 2007 to the
present for inpatient cases with ICD-9-CM code 260 assigned
as a principal or secondary diagnosis code. Cases with ICD-
9-CM code 260 assigned should be reviewed for accuracy for
documentation and the clinical components of malnutrition.
Facilities should then determine whether the terminology clinicians are using requires further clarification.
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