Malnutrition Coding Denials in the Acute Care Setting

Medicare and most other insurers use a payment model based on medical diagnoses, including malnutrition, to reimburse hospitals for a patient's stay. Including a malnutrition code on the insurance claim can sometimes increase hospital reimbursement. However, an insurer may issue a denial for any diagnostic code if they believe the medical record documentation submitted with the claim is insufficient to support application of the code. This may occur with malnutrition codes when documentation of the malnutrition criteria is not specific, is contradictory, lacks a treatment plan, or does not demonstrate that malnutrition impacted the costs of care. It is therefore important that registered dietitian nutritionists thoroughly document the malnutrition diagnosis and treatment plan and communicate their findings with the provider. Hospitals may appeal denials; registered dietitian nutritionists should be involved in this process and make note of potential gaps in documentation to further bolster future documentation and prevent malnutrition code denials.