Health Information Management

Q&A: Coding for protein malnutrition

HIM-HIPAA Insider, December 28, 2010

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Q: Our physician provided an illegible diagnosis of malnutrition, and when we queried him regarding the specific type of malnutrition, he provided protein malnutrition. The ICD-9-CM Manual directs us to assign code 260; however, a consultant told us this is incorrect because this code represents Kwashiorkor. In your opinion, what should we do?

A: Based on Coding Clinic, third quarter 2009, I would report ICD-9-CM code 263.9 (unspecified protein-calorie malnutrition) if you cannot obtain the information that would accurately classify the malnutrition as mild or moderate. The Coding Clinic reference previously mentioned states that coders should not report ICD-9-CM code 260 when the provider does not specifically document Kwashiorkor. Coding Clinic also states:
Kwashiorkor syndrome is a condition that is caused by severe protein deficiency that is usually seen in some underdeveloped areas in Africa and Central America; however it is extremely rare in the United States. The National Center for Health Statistics (NCHS) is considering a proposal to revise the index entries under mild and moderate protein malnutrition in order to provide clearer direction to the coder.
Editor’s note: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding at HCPro, Inc., in Marblehead, MA, answered this question, which originally appeared in the December issue of Briefings on Coding Compliance Strategies.

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