News: OIG fines another facility for inappropriate Kwashiorkor claims
CDI Strategies, April 24, 2014
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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
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