Malnutrition has become a major concern over the past few years, especially among the elderly. The incidence of malnutrition in elderly hospitalized patients ranges from 12 to 50% and from 23 to 60% percent among institutionalized senior citizens.
Many elderly Medicare patients, especially those who are severely ill, are malnourished. Malnutrition can result from the treatment of another condition, inadequate treatment or neglect, or the general deterioration of a patients health. Malnourished patients have an increased duration of recovery from their primary illness, often experience increased hospital stays and consume more resources for proper treatment.
Reimbursement to cover additional costs may only be realized if the malnutrition is identified, diagnosed and treated by the physician while providing care for the primary illness. It is imperative for providers to understand the criteria needed to identify document malnutrition in order to maximize nutrition interventions to ensure best outcomes, and also capture reimbursement for the additional care provided.
Medicare sets forth a number of Federal requirements, including the Social Security Act § 1862(a)(1)(A), related to billing for the treatment of severe malnutrition. Hospitals are allowed to bill for the treatment of malnutrition on the basis of the severity of the condition - mild, moderate, or severe, and whether it affects patient care.
Severe malnutrition is classified as a major complication or comorbidity (MCC). Adding an MCC to a Medicare claim can result in a higher Medicare payment because the claim is coded at a higher Diagnosis Related Group.
Currently, the U.S. follows coding criteria set forth by the American Society for Parenteral and Enteral Nutrition (ASPEN). However, the standard clinical criteria for diagnosing severe malnutrition is actively evolving. For now, use the codes below to capture reimbursement for malnourished patient claims.
