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Malnutrition coding shortfalls in A ustralian and N ew Z ealand hospitals
Author(s) -
Agarwal Ekta,
Ferguson Maree,
Banks Merrilyn,
Bauer Judith,
Capra Sandra,
Isenring Elisabeth
Publication year - 2015
Publication title -
nutrition and dietetics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.479
H-Index - 31
eISSN - 1747-0080
pISSN - 1446-6368
DOI - 10.1111/1747-0080.12116
Subject(s) - malnutrition , medicine , wasting , cohort , prospective cohort study , weight loss , acute care , pediatrics , body mass index , health care , obesity , economics , economic growth
Aim The I nternational C lassification of D iseases, version 10, A ustralian modification ( ICD ‐10‐ AM ) is used to classify diseases in hospital patients in A ustralia and N ew Z ealand. ICD ‐10‐ AM defines malnutrition as ‘[body mass index] BMI <18.5 kg/m 2 or unintentional weight loss of ≥5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting’. The A ustralasian N utrition C are D ay S urvey ( ANCDS ) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from A ustralian and N ew Z ealand hospitals. This study determined if malnourished participants were assigned malnutrition‐related codes according to ICD ‐10‐ AM . Methods The ANCDS recruited acute care patients from 56 hospitals. Hospital‐based dietitians evaluated participants' nutritional status using BMI and S ubjective G lobal A ssessment ( SGA ). In keeping with the ICD ‐10‐ AM definition, malnutrition was defined as BMI <18.5 kg/m 2 , SGA ‐ B (moderately malnourished) or SGA ‐ C (severely malnourished). After 3 months, in this prospective cohort study, staff members from each hospital's health information/medical records department provided coding results for malnourished participants. Results Malnutrition was prevalent in 30% (n = 869) of the cohort (n = 2976) and a significantly small number of malnourished patients were coded for malnutrition (n = 162, 19%, P < 0.001). In 21 hospitals, none of the malnourished participants were coded. Conclusions This is the largest study to provide a snapshot of malnutrition coding in A ustralian and N ew Z ealand hospitals. Findings highlight gaps in malnutrition documentation and/or subsequent coding, which could potentially result in significant loss of casemix‐related revenue for hospitals. Dietitians must lead the way in developing structured processes for malnutrition identification, documentation and coding.