Health Information Management

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.

Kwashiorkor is a form of severe protein malnutrition which typically afflicts children in so-called “third-world” countries during famine and is particularly rare in the United States. However, during calendar years 2010 and 2011 Medicare paid more than $700 million for Kwashiorkor-related claims.  

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:

 



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