Health Information Management

News: OIG sites two San Antonio facilities for Kwashiorkor errors

CDI Strategies, March 5, 2015

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

For calendar years (CYs) 2010 and 2011, Medicare paid hospitals $711 million for claims that included a diagnosis code for Kwashiorkor, a form of severe protein malnutrition typically found in third-world countries that is extremely rare in the United States. The OIG has vigorously reviewed the high volume of claims for the disease during the past several years, citing many facilities and recouping thousands of dollars. Two San Antonio facilities—Baptist Health System and Methodist Hospital—are the latest to fall under OIG scrutiny.

Baptist received $7,689,318 from Medicare for Kwashiorkor care, according to a recent OIG report. After examining 102 of the 468 inpatient hospital claims, the OIG found that none of the claims were accurate, and that the hospital should have coded for another form of malnutrition or no malnutrition code at all. For its part, Baptist Health pointed to confusing coding requirements and agreed to address the situation.

At Methodist, the OIG found that none of the 124 claims audited met requirements for Kwashiorkor.

“Hospital officials attributed errors to a lack of clarity in the coding guidelines and issues with the medical coding software program used to code the diagnoses,” according to the report

CDI professionals can help ensure that physician documentation accurately reflects appropriate malnutrition documentation, and work with physicians and coders to prevent inappropriate Kwashiorkor coding.

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 ...”

Editor’s Note: For additional information and recommendations regarding CDI role in capturing malnutrition diagnoses consider reading the following articles:

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

    Briefings on APCs
  • 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