Identification, Coding, and Reimbursement of Pediatric Malnutrition at an Urban Academic Medical Center

Nutr Clin Pract. 2018 Oct;33(5):640-646. doi: 10.1002/ncp.10064. Epub 2018 Mar 12.


Background: The American Academy of Nutrition and Dietetics and the American Society of Parenteral and Enteral Nutrition released a pediatric malnutrition consensus statement in 2014 recommending the use of z-scores as indicators for identification and documentation of malnutrition. A shift in focus is needed on standardizing pediatric malnutrition language at institutions nationwide to make study data comparable. With this standardized language, establishment of institutional baselines for identification, coding, and reimbursement of pediatric malnutrition is crucial to measure process improvements.

Objectives: The objectives of this study were to determine the prevalence of malnutrition among pediatric patients at an urban academic medical center, the frequency of malnutrition codes used, and the reimbursement impact of coding for malnutrition.

Methods: Electronic medical records of pediatric patients admitted from January 2013 to December 2015 were reviewed. Malnutrition was identified based on registered dietitian identification and z-score. Patients given a malnutrition-related International Classification of Diseases code upon discharge were identified. A reimbursement calculation was performed: the malnutrition-related International Classification of Diseases code was removed to determine the difference in reimbursement with vs without the code.

Results: Of the 1,532 admissions included in this study, 464 (30%) were identified as malnourished. A total of 152 (33%) malnourished patients were given a malnutrition-related secondary diagnosis. The calculation revealed that coding for malnutrition resulted in an additional $27,665.70 to the medical center.

Conclusion: Malnutrition coding may have a significant financial impact and processes improvement efforts can be made to improve malnutrition coding.

Keywords: clinical coding; diagnosis-related groups; health insurance reimbursement; hospital costs; international classification of diseases; malnutrition; nutrition status; pediatrics.

MeSH terms

  • Academic Medical Centers / economics
  • Child
  • Child Nutrition Disorders / diagnosis*
  • Child Nutrition Disorders / economics
  • Child Nutrition Disorders / epidemiology
  • Clinical Coding*
  • Consensus
  • Diagnosis-Related Groups* / economics
  • Diagnosis-Related Groups* / standards
  • Dietetics
  • Documentation / economics
  • Documentation / standards
  • Electronic Health Records
  • Enteral Nutrition
  • Female
  • Hospital Costs*
  • Hospitalization
  • Humans
  • Insurance, Health, Reimbursement*
  • International Classification of Diseases
  • Male
  • Malnutrition / diagnosis*
  • Malnutrition / economics
  • Malnutrition / epidemiology
  • Nutritional Status*
  • Nutritionists
  • Parenteral Nutrition
  • Prevalence
  • Retrospective Studies
  • Societies