Coding Notes
Facilities should discuss the review findings with medical
staff and provide education on the correct coding for code
260. They should collaborate with the medical staff on a plan of
action to improve the documentation of malnutrition and share
the findings with the coding staff, clinical documentation improvement staff, and nutritionists who may query physicians on
the nutritional diagnosis or status. Organizations should consider generating physician queries concurrently through a clinical documentation improvement program.
If all documentation improvement efforts fail, coding professionals should query physicians to clarify malnutrition
documentation. Organizations should follow references and
resources to ensure an effective query process, including the
October 2008 AHIMA practice brief “Managing an Effective
Query Process,” available in the AHIMA Body of Knowledge at
www.ahima.org. They should use a physician query that offers a
brief explanation and choices for the physician so they can better understand the malnutrition classification.
Coding professionals must apply basic coding competencies when they see proper malnutrition documentation. Since
kwashiorkor is not often seen in the United States, coding professionals should review the clinical documentation and clinical indicators carefully and ultimately query when clarification
is appropriate. Accurate documentation, coding, and reimbursement will help maintain compliance and diminish potential regulatory risk. ¢
HEaltH CarE
adMinistration
UMUC13345_HCA_JrnlOf AHIMA_7.25X4.625.indd 1
Notes
1.Ne w York Times. “Malnutrition.” http://health.nytimes.
com/health/guides/disease/malnutrition/ overview.html.
2. The Merck Manuals. Robert S. Porter and Justin L. Kaplan,
eds. Whitehouse Station, NJ: Merck, 2010.
3. Williams, Lance, Christina Jewett, and Stephen K. Doig.
“Hospital Chain, Already under Scrutiny, Reports High
Malnutrition Rates.” San Francisco Chronicle, February 19,
2011. http://californiawatch.org/category/free-tagging/
kwashiorkor.
References
American Hospital Association. ICD-9-CM Coding Clinic,
Third Quarter, 2009.
American Hospital Association. ICD-9-CM Coding Clinic,
Fourth Quarter, 1992.
Ingenix. ICD-9-CM for Hospitals 2011. Salt Lake City, UT:
Ingenix, 2010.
Kivumbi. “Difference between Kwashiorkor and Marasmus.”
November 21, 2009. www.differencebetween.net/science/
health/difference-between-kwashiorkor-and-marasmus.
National Center for Health Statistics. “2011 ICD-10-CM.” www.
cdc.gov/nchs/icd/icd10cm.htm.
Gloryanne Bryant ( gloryanne.h.bryant@kp.org) is regional managing director of HIM revenue cycle at Kaiser Permanente in Oakland, CA.
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