Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois, USA.
Department of Food and Nutrition, Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida, USA.
Nutr Clin Pract. 2018 Oct;33(5):640-646. doi: 10.1002/ncp.10064. Epub 2018 Mar 12.
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.
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.
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.
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.
Malnutrition coding may have a significant financial impact and processes improvement efforts can be made to improve malnutrition coding.
美国营养与饮食学会和美国肠外与肠内营养学会于 2014 年发布了儿科营养不良共识声明，建议使用 z 评分作为识别和记录营养不良的指标。全国各机构需要将儿科营养不良语言标准化，以确保研究数据的可比性，这就需要将重点转移到这方面。使用这种标准化语言，对于确定、编码和报销儿科营养不良机构基准至关重要，这对于衡量流程改进非常重要。
本研究的目的是确定城市学术医疗中心儿科患者的营养不良患病率、使用营养不良代码的频率以及编码营养不良的报销影响。
回顾了 2013 年 1 月至 2015 年 12 月期间入院的儿科患者的电子病历。根据注册营养师的识别和 z 评分确定营养不良。确定出院时给予与营养不良相关的国际疾病分类代码的患者。进行了报销计算：去除与营养不良相关的国际疾病分类代码，以确定有或没有代码的报销差异。
本研究共纳入 1532 例住院患者，其中 464 例（30%）被确定为营养不良。共有 152 名（33%）营养不良患者被给予与营养不良相关的次要诊断。计算结果表明，编码营养不良导致医疗中心额外增加了 27665.70 美元的收入。
营养不良编码可能会产生重大的财务影响，可以采取措施改进营养不良编码，以提高流程改进效果。
