News: OIG fines another facility for inappropriate Kwashiorkor claims
CDI Strategies, April 24, 2014
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
Oakwood Hospital and Medical Center (the Hospital), in Dearborn, Mich., is the latest facility to fall under the sights of the Office of the Inspector General (OIG) for inappropriately assigning diagnosis code 260 for Kwashiorkor.
In February Christus Saint Vincent Regional Medical Center, in Santa Fe, and Des Moines-based Mercy Health Network were both investigated, resulting in $150,000 and $90,000 in overbilling respectively.
In 2011, University of Maryland Medical System faced up to $8 million in fraud charges for inappropriate use of the code as did several California hospitals associated with Prime Healthcare.
AHA’s Coding Clinic for ICD-9-CM, Third Quarter 2009 states that coders should not report ICD-9-CM code 260 when the provider does not specifically document Kwashiorkor.
Coding Clinic also states:
“Kwashiorkor … 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 ...”
For additional information, consider reading the following ACDIS/HCPro articles on the subject:
- Take a closer look at clinical indicators of malnutrition
- Malnutrition continues to be area of clinical concern
- More on potential pitfalls of malnutrition documentation
- Feeding the brain on malnutrition documentation
- Q&A: Members of ACDIS advisory board offer advice on querying for malnutrition
- Malnutrition: Understand the clinical diagnosis and coding guidance
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
Related Products
-
Briefings on APCs
Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...
-
HIM Briefings
Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...
-
Briefings on Coding Compliance Strategies
Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...
-
Briefings on HIPAA
How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...
-
APCs Insider
This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Practice the six rights of medication administration
- Q&A: Primary, principal, and secondary diagnoses
- What to include on the incident report
- Diagnostic v. screening mammogram based on referring physician’s order
- OB services: Coding inside and outside of the package
- What does case-mix index mean to you?
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- Neurological checks for head injuries
- E-mailed
-
- CDC: First Case of Wuhan Coronavirus Confirmed in U.S.
- What to include on the incident report
- Ask yourself: Could your CDI program work at home?
- Know guidelines and subtle differences in code descriptions for laceration repairs
- Joint Commission now allows partially-used oxygen canisters in 'full' rack
- Joint Commission addresses nurse burnout
- How to assign the correct ED E/M code
- Five keys to creating a CHF disease management program
- Documentation challenges for skin and dermatology coding
- Do not use pathology measurements to report a lesion's size
- Searched
