Malnutrition coding shortfalls in australian and new zealand hospitals

Agarwal, Ekta, Ferguson, Maree, Banks, Merrilyn, Bauer, Judith, Capra, Sandra and Isenring, Elizabeth (2014) Malnutrition coding shortfalls in australian and new zealand hospitals. Nutrition and Dietetics, 72 1: 69-73. doi:10.1111/1747-0080.12116

Author Agarwal, Ekta
Ferguson, Maree
Banks, Merrilyn
Bauer, Judith
Capra, Sandra
Isenring, Elizabeth
Title Malnutrition coding shortfalls in australian and new zealand hospitals
Journal name Nutrition and Dietetics   Check publisher's open access policy
ISSN 1446-6368
Publication date 2014-03-24
Year available 2014
Sub-type Article (original research)
DOI 10.1111/1747-0080.12116
Open Access Status
Volume 72
Issue 1
Start page 69
End page 73
Total pages 5
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2015
Language eng
Formatted abstract
Aim: The International Classification of Diseases, version 10, Australian modification (ICD-10-AM) is used to classify diseases in hospital patients in Australia and New Zealand. ICD-10-AM defines malnutrition as '[body mass index] BMI <18.5kg/m2 or unintentional weight loss of ≥5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting'. The Australasian Nutrition Care Day Survey (ANCDS) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from Australian and New Zealand 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 Subjective Global Assessment (SGA). In keeping with the ICD-10-AM definition, malnutrition was defined as BMI <18.5kg/m2, 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 Australian and New Zealand 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.
Keyword Casemix
International Classification of Diseases
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 24 March 2014.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Human Movement and Nutrition Sciences Publications
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