Q&A: Malnutrition query results in additional confusion

January 20, 2011

Q: Our physician provided an illegible diagnosis of malnutrition, and when we queried him regarding the specific type of malnutrition, he provided protein malnutrition. The ICD-9-CM Coding Manual directs us to assign code 260; however, a consultant told us this is incorrect because this code represents Kwashiorkor. What should we do?

A: If you cannot obtain information that accurately classifies the malnutrition as mild or moderate, I would report ICD-9-CM code 263.9 (unspecified protein-calorie malnutrition) based on AHA’s Coding Clinic for ICD-9-CM, third quarter 2009. Coding Clinic states that coders should not report ICD-9-CM code 260 when the provider does not specifically document Kwashiorkor. Coding Clinic also states:

“Kwashiorkor syndrome is a condition that is caused by severe protein deficiency that is usually seen in some underdeveloped areas in Africa and Central America; however it 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 to the coder.”

Editor’s Note: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding at HCPro, Inc., in Marblehead, MA, answered this question, which originally appeared in the December issue of Briefings on Coding Compliance Strategies.

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