Malnutrition definitions in clinical practice: To be E43 or not to be?

Abstract

Malnutrition is a disease that imposes a significant healthcare cost burden in the United States, especially when left undiagnosed and untreated for an extended period of time. This article discusses traditional malnutrition diagnostic criteria for adults and why registered dietitian nutritionists and physicians should no longer use these criteria to determine nutrition status. It concludes with the malnutrition clinical characteristics currently accepted in the United States and globally, with implications for practice. Clinical documentation specialists and medical coders can use this information to better interpret medical record documentation and assign the correct International Classification of Diseases, 10th Revision, Clinical Modification codes to the coding abstract.

Current Practices Using Pediatric Malnutrition Indicators: A Survey of Dietitians Working in Pediatrics

“…12 Current practice standards and quality improvement initiatives promote use of specific ICD-10 codes for malnutrition documentation to better understand patients' severity of malnutrition, to ensure consistency with the verbiage in updated malnutrition literature, and to optimize quality ratings and hospital reimbursement through the Medicare Severity Diagnostic Related Group and All Patient Refined Diagnostic Related Groups billing and coding systems. 16,17,25,26 The goal for the PMN indicators to lead to the development of accurate estimations of prevalence and incidence requires diagnosis by the provider assigned the care of the patient and accurate coding of the diagnosis of malnutrition. According to the survey results, only approximately 40% of physicians were documenting malnutrition.…”

“…The authors concluded that despite these clinical associations and improvements in coding rates, PMN remains underdiagnosed in inpatient settings 12 . Current practice standards and quality improvement initiatives promote use of specific ICD‐10 codes for malnutrition documentation to better understand patients’ severity of malnutrition, to ensure consistency with the verbiage in updated malnutrition literature, and to optimize quality ratings and hospital reimbursement through the Medicare Severity Diagnostic Related Group and All Patient Refined Diagnostic Related Groups billing and coding systems 16,17,25,26 …”

Malnutrition and liver disease in a developing country

“…Malnutrition (undernutrition) is defined as an insufficient intake or assimilation of nutrients essential for development and prevention of disease[ 1 ]. Malnutrition presents as a common complication of end-stage liver failure (cirrhosis), which is characterized by mass systemic complications such as refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome and variceal hemorrhage[ 2 ].…”

The role of health classifications in health information management

“…Cappetta et al (2020) reported on a study where the under-coding of dementia highlighted opportunities to improve identification and management of dementia. Resslar et al (2019: 102) reported on several studies that challenge “the belief that administrative data can be compared across hospitals” (Kaafaran et al, 2011; Koch et al, 2012; Parker et al, 2006; Scott and Ward, 2006) and argued that “inaccurate information is currently used for purposes never intended by ICD-9-CM designers.” Phillips et al (2019) in their discussion of the documentation and coding of malnutrition highlight the challenges that occur when the classification does not reflect current clinical terminology and encourage documentation specialists to work to address this. Alonso et al (2020: 32) conducted focus groups to identify the factors in the medical records that adversely impact on accurate and useful classification outcomes.…”