Note from the ACDIS Editor: ACDIS resources on malnutrition

By Linnea Archibald

The diagnosis of malnutrition has long been in the sights of the Office of Inspector General (OIG) for audits and denials. In fact, just as recently as December 2017, the OIG found that of 2,145 inpatient claims from 2006-2014 at 25 providers, all but one incorrectly included the diagnosis code for kwashiorkor. This resulted in overpayments in excess of $6 million.

Because of the high level of scrutiny applied to these claims, CDI professionals focused on accurately capturing patients’ nutritional status—and that is no easy task. While a dietitian may be consulted, and may document a body mass index (BMI) far under the normal range, physicians often miss the diagnosis in their own documentation/progress notes, or document in such a way that leads to the coder assigning the wrong type of malnutrition , leading, in turn, to a denial down the road.

Since this is such a large, ever-present issue for CDI professionals, ACDIS has assembled a number of resources to help you make sense of it all and ensure your records are complete, clear, accurate, and audit proof.

First, if you’re looking for education to provide physicians at your facility, make a stop at the ACDIS Resource Library. Tonya Motsinger, MBA, BSN, RN, system director of CDI at Ohio Health in Columbus, and Deanne Wilk, BSN, RN, CCDS, manager of CDI at Penn State Health in Hershey, have both provided malnutrition tip cards used at their facilities as references for the physicians.

If you’re in need of some help formulating malnutrition queries, several CDI industry leaders have unpacked some tactics this year on the ACDIS Blog. 

Denials can be a strong driver for change or CDI purview expansion, and there are a number or resources available to help you audit proof the malnutrition documentation at your facility as well.

To begin your research, watch last year’s CDI Week webinar with Boot Camp Instructors Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, and Allen Frady, RN, BSN, CCS, CCDS, CRC, on clinical validation—a large portion of the program focused on malnutrition criteria and documentation.

Then, give last week’s episode of ACDIS Radio a listen (you can also listen on Apple Podcasts). On the episode, Vaughn M. Matacale, MD, CCDS, the director of the clinical documentation advisor program at Vidant Health in Greenville, North Carolina, shares the story of  their fight against OIG audit findings related to malnutrition. While he (and other members of their team) presented at the 2018 ACDIS conference, too, they’ll also be speaking on a three-hour ACDIS Live! case study webinar later this year.

ACDIS also has resources for CDI professionals dealing with malnutrition headaches in the pediatric world. To start with, take a look at Valerie A. Bica, BSN, RN, CPN, and Michelle Limo, MSN, RN, CCDS, CCS’s presentation from the 2018 conference on the topic. Then, if you still need some advice, take it to the pediatric thread on the ACDIS Forum.

Ultimately, even though malnutrition is a tricky subject ACDIS can help connect you to valuable resources vetted by your peers. That’s what ACDIS is really all about—CDI professionals helping each other to further the mission of the field.

Editor’s note: Archibald is the editor for ACDIS. Contact her at larchibald@acdis.org. Do you have a CDI resource to share? Send it to Archibald for review by the Forms & Tools Committee for publishing in the ACDIS Resource Library.