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Protein-Calorie Malnutrition

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Protein-Calorie Malnutrition OCTOBer 2010 Informative and educational updates for providers FOCUS ON: ProteIN-CalorIe Always… • Document to the greatest degree of certainty based on MALNUTrITION your clinical judgment as to whether PCM exists. • When documenting cachexia or wasting disease, This is an energy deficit due to a chronic deficiency of all remember to document and report first the underlying macronutrients and many micronutrients. In developed countries, condition as well. it is primarily seen in people with other illnesses and in the institutionalized elderly.1 The disorders that may exist in conjunction 5 with, and contribute to, protein calorie malnutrition include disorders Documentation and Coding Tips that impair absorption or metabolism or decrease appetite such as: chronic pancreatitis, chronic liver disease, cancer, eSrD and • Be careful not to document protein-calorie malnutrition as: substance abuse.2 While there is no definitive diagnostic test for PCM, • Abnormal Weight Loss 783.21 the subjective global assessment consists of six parameters and the • Loss of Appetite 783.0 clinician’s judgment as to whether PCM exists:3 • Underweight 783.22 a. Unremitting involuntary weight loss, especially greater than 10% of prior weight • Anorexia 783.0 b. Severely curtailed food intake • Failure to Thrive (Adult) 783.7 c. Muscle wasting or fat loss (with edema and ascites on These are categorized as Symptoms, Signs and Ill-Defined physical exam) Conditions in the ICD-9-CM and do not report the patient’s condition to the greatest degree of specificity. d. Persistent GI symptoms such as anorexia, emesis or diarrhea e. Marked reduction in physical capacity • Protein-calorie malnutrition can be documented by degree in two ways: f. Metabolic stress such as in sepsis or trauma • Mild, moderate, severe Any combination of these is an indicator of PCM. • First, second, third ICD-9 Code Diagnostic • Wasting disease due to malnutrition is coded as 261 – Code Description Criteria Nutritional marasmus and includes nutritional atrophy, severe calorie deficiency and severe malnutrition, not 263.0 Malnutrition of “Second Degree” Characterized otherwise specified. Moderate Degree by superimposed biochemical changes in electrolytes, lipids, • Protein-calorie malnutrition that is documented as severe blood plasma4,5 or third degree is coded as 262 - Other severe protein- calorie malnutrition and includes nutritional edema 263.1 Malnutrition of Mild “First Degree” Characterized by without mention of dyspigmentation of skin and hair. degree tissue wasting in an adult, but few or no biochemical changes4 • Nutritional edema with dyspigmentation of skin and hair is coded as 260 – Kwashiorkor. 263.8 Other Protein 4 Calorie Malnutrition Not elsewhere specified 263.9 Unspecified Protein Dystrophy due to malnutrition Calorie Malnutrition Malnutrition (calorie) NOS5 799.4 Cachexia Wasting disease; general ill health and poor nutrition.4 Code first for underlying condition if known.5 The information presented herein is for informational purposes only. It is not intended, nor is it to be 1 http://www.merck.com/mmpe/sec01/ch002/ch002b.html used, to define a standard of care or otherwise substitute for informed medical evaluation, diagnosis and 2 CMAJ, Nov 13, 2001 “Clinical nutrition: Protein energy malnutrition in inpatient settings” treatment which can only be performed by a qualified medical professional. Ingenix, Inc. does not warrant 3 HHS and CMS: (Aug. 2008) Intent and definitions: CMS Manual System Pub 100-07. or represent that the information contained herein is accurate or free from defects. 4 Ingenix 2010 Coders’ Desk reference for Diagnoses. USA: Ingenix, 2009. Print., pp. 264, 648. This information is for informational purposes only and does not replace the professional judgment and 5 Ingenix 2010 ICD-9-CM Professional for Physicians. 6th ed. 2 vols. USA: Igenix, 2009. Print. expertise of the individual performing coding based on numerous factors including, but not limited to, documentation in the medical record and other industry recognized coding guidance. Because codes, coding requirements and standards can and do change, the individual assigning codes is reminded to verify the accuracy, specificity, currency and acceptability of such codes and coding methods used. For more information on Ingenix and the products and services we offer, contact us at www.ingenix.com or call (800) 765-6713. If you have questions or wish to be removed from this fax, please contact your local Ingenix Market Consultant. © Ingenix 2010 IN064.
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