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 Maximizing
Reimbursement Opportunities
Frank N. Konstantinides, MT, MS
Clinical Associate Professor
College of Pharmacy
University of Minnesota
St. Paul, MN
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Malnutrition is Typically a Comorbid
Condition
The proper assessment of malnutrition and the assignment
of appropriate diagnostic codes have enabled institutions
with nutrition support programs to significantly
increase their reimbursement levels. In many cases,
the increased reimbursement has more than offset
the incremental costs of effective nutrition support.
Malnutrition is usually seen as a comorbid condition
to the primary reason that precipitated the hospitalization.
In many cases, listing malnutrition as a comorbidity
through DRG codes triggers additional Medicare, Medicaid,
or private insurance reimbursement. The chart below
illustrates the increased Medicare reimbursement
that results from co-coding malnutrition.
Co-coding Malnutrition
Increases Medicare Reimbursement
|
Disease/Procedure
|
DRG Code
|
Normal
Reimbursement
|
Reimbursement
w/Co-coded Malnutrition
|
|
Transurethral Prostatectomy
|
336 |
$1806 |
$2608 |
| Cellulitis |
277 |
$2537 |
$3808 |
| Simple Pneumonia |
89 |
$2082 |
$3280 |
| Respiratory Infection |
79 |
$2873 |
$5010 |
| GI Hemorrhage |
174 |
$1637 |
$2631 |
| Rectal Resection |
146 |
$4745 |
$7491 |
| Hip & Femur Procedure |
210 |
$5692 |
$8027 |
Source: Mears 1994
The ICD-9-CM Codes for malnutrition and malnutrition-related conditions are
listed in the chart below:
ICD-9-CM Code Classification
for Malnutrition
|
ICD-9-CM
Code
|
Description
|
Criteria
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| 260 |
Kwashiorkor |
Nutritional edema with dyspigmentation of skin
and hair |
| 261 |
Nutritional Marasmus |
Nutritional atrophy; severe malnutrition not otherwise
stated;
severe energy deficiency |
| 262 |
Other Protein-Calorie Malnutrition |
No definition given |
| 263.0 |
Malnutrition of Moderate Degree |
Weight for age 60% to <75% of standard |
| 263.1 |
Malnutrition of Mild Degree |
Weight for age 75% to <90% of standard |
| 263.8 |
Other Protein-Energy Malnutrition |
No definition given |
Providers should consult their payers for details
on, and for any limitations on, the amount of increased
reimbursement for malnutrition as a co-morbid condition.
Find out the level of reimbursement for various protein
markers by clicking
here, then simply select your state and scroll
to the appropriate marker.
Reimbursement
Levels for Selected Protein Markers by State
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