1. Minimal assignment of ICD-9 codes relating to malnutrition to a sample of malnourished, hospitalized patients
Contributors: Jessica Moehling, BS; Anne Coltman, MS, RD, CNSC; Diane Sowa, MBA, RD; Sarah Peterson, PhD, RD, CNSC; Omar Lateef, DO
RUSH UNIVERSITY
MEDICAL CENTER
Results
Introduction
Patients had a mean age of 66.0 years, BMI of 24.9 kg/m2, and hospital length of stay of 4.2 days. Only 4 patients (5%) were coded with an ICD-9 malnutrition code. Only 3 distinct malnutrition codes were used; the most common was “malnutrition of moderate degree (50%).”
Despite the fact that malnutrition is recognized as a significant issue in the hospital setting and dietitians document patients with malnutrition, physicians rarely include malnutrition as a medical diagnosis. The International Classification of Diseases, Ninth Revision (ICD-9), is a healthcare classification system used to indicate diagnostic codes and reimbursement for disease states and medical interventions in hospitalized patients. Only a limited number of ICD-9 codes directly address malnutrition. The purpose of this quality improvement project was to determine the occurrence of ICD-9 codes related to malnutrition in a sample of malnourished hospitalized patients.
Discussion
Few patients documented as malnourished by the dietitian had malnutrition as a diagnosis and an ICD-9 malnutrition code. Since this study, several process improvement initiatives were implemented in attempt to ensure better coding for malnutrition at the previously mentioned medical center. First, updates to the EPIC flowsheets utilized by dietitians at the medical center now include a row which allows for selection of malnutrition severity and/or body mass index (BMI). Second, if a dietitian selects a level of malnutrition severity in the new flowsheet row, providers receive a best practice alert (BPA), prompting the primary team to add the indicated level of malnutrition severity directly into the patient’s problem list. Further data will need to be collected in order to determine if these process improvement initiatives result in greater coding for malnutrition.
Methods
A convenience sample of 74 malnourished adult patients from a large, urban university medical center was used. Patients were assessed by a dietitian using Subjective Global Assessment (SGA); only patients with an SGA of B or C were included. A retrospective chart audit determined assignment of ICD-9 malnutrition codes. The organization’s IRB approved this project. Descriptive statistics, counts and percentages were used to describe the sample.
Figure 1.
Figure 2. Rough draft of FNS Med Surg/Critical Care flowsheet update
Figure 1. Rough draft of malnutrition BPA