tein supplementation in children with severe protein calorie malnutrition and returns to normal levels within eight days.6,11 These ob-servations and others led to the recommen- Check. The primary requirement for hospice admission is that a physician certifies the patient probably has six or fewer months to live, if the disease runs its natural course. The timeline is not a hard and fast rule, since doctors cannot know when a patient will die, but six months is the general guideline. Adult failure to thrive is associated with multiple underlying conditions. Nutritional Marasmus is a form of serious protein-energy malnutrition that is caused by a deficiency in calories and energy and is found primarily in children. The NFPE is a system-based examination of each region of the body to assess for physical findings related to nutrition. Other severe protein-calorie malnutrition became unspecified severe protein-calorie malnutrition, diagnosis code E43. E42 Marasmic kwashiorkor. CGS has developed a hospice LCD, ID# L34538 titled Hospice Determining Terminal Status, using the National Hospice and Palliative Care Organization's (NHPCO) guidelines. Protein-energy malnutrition (PEM) is classically described as 1 of 2 syndromes, marasmus and kwashiorkor, depending on the presence or absence of edema. The lack of all nutrients in the body can result in the following conditions: 1. For a patient to be eligible for hospice, consider the following guidelines: The illness is terminal (a prognosis of ≤ 6 months) and the patient and/or family has elected palliative care. The patient has a declining functional status as determined by either: Palliative Performance Scale (PPS) rating of ≤ 50%-60%. Height and weight should be measured rather than estimated to determine body mass index (BMI) and weight changes. E45 Retarded development following protein-calorie malnutrition. In fifty infants with early and severe protein-calorie malnutrition, an essentially ambulatory treatment was pursued by a multiprofessional health group from the South-western Area of Santiago attaining nutritional recovery in all of them. Each type may be classified as acute or chronic. Jane White, James S. Kennedy, MD, CCS, CDIP, and Alice Zentner, RHIA, describe the new guidelines and what coders need to know about malnutrition coding. E44 Protein-calorie malnutrition of moderate and mild degree. Severe Protein Calorie Malnutrition (>2 of the following characteristics) Obvious significant muscle wasting, loss of subcutaneous fat. For example, according to the criteria for the acute context, 1% weight loss in one week with caloric intake less than 75% of needs constitutes malnutrition, while 2% weight loss in one week with caloric intake less than 50% of needs for five days would represent severe malnutrition. •Ongoing data collection efforts for possible future hospice refinements, including a case mix system for payment. Checklist: Documenting Malnutrition (E41 and E43) This checklist is intended to provide Healthcare providers with a reference for use when responding to Medical Documentation Requests for services rendered and hospital admissions to treat Malnutrition. It also employs palpation, which requires the use of touch with the tips and pads of fingers to evaluate and assess texture, size, and tenderness. The exam requires a critical eye to determine color, shape, texture, and size of the patient. Even though there are a … Results: 51% of patients (95% Cl = 31% to 70%) had evidence of subtle vitamin K depletion as defined by a subnormal plasma phylloquinone concentration. Whew. Hospice Eligibility. Illnesses that may qualify for hospice care include, but are not limited to: Metastatic Cancers. Heart Disease. Kidney Disease. Liver Disease. Lung Disease Stroke and/or Coma. AIDS. GLIM Criteria for the Diagnosis of Malnutrition MUST have 1 phenotypic and 1 etiologic criteria to diagnose the PRESENCE of malnutrition. Many patients exhibit symptoms of both disease states. Sep 12, 2013. E43 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Prealbumin production decreases after 14 days of consuming a diet that provides only 60 percent of required proteins. 3. • Non-hospice payments for DME, medications , treatments, inpatient stays, etc. Additionally, marasmus can precede kwashiorkor. 783.22 . E44.1 Mild. Documentation of the following factors will support eligibility for hospice care: Progressive malnutrition; Muscle wasting with reduced strength and endurance; Continued active alcoholism (> 80 gm ethanol/day); Hepatocellular carcinoma; HBsAg (Hepatitis B) positivity; Hepatitis C refractory to interferon treatment. They would use ICD-10-CM code E42 to report severe protein-calorie malnutrition with signs of both kwashiorkor and marasmus. Marasmus: marasmus results from both protein and energy deficiency, and it is usually characterized by general weakness, lack of interest and wasting. Supporting evidence for hospice eligibility: • Progressive malnutrition • Muscle wasting with reduced strength • Ongoing alcoholism (>80 gm ethanol/day) • Hepatocellular carcinoma • Hepatitis B surface antigen positive • Hepatitis C refractory to interferon treatment 2. 263.8 . This imbalance causes tissue loss, in particular of muscle tissue, with harmful functional consequences. E640. Follow-up 26 7. •Non‐hospice payments for DME, medications, treatments, Underweight Use additional code to identify BMI, if known (Z68.-). 4. current coding guidelines, as well as, admission requirements for hospice certifications. E46. E40 Kwashiorkor. MCD Reports provide key insights into National and Local Coverage data. E41 Nutritional marasmus. Include all that apply. Protein Calorie Malnutrition Coded Prevalence in the United States AHRQ Agency for Healthcare Research and Quality •4.5% of all inpatient stays (2013) DM&A •5.6% of all inpatient stays (2016) Source: Characteristics of Hospital Stays Involving Malnutrition, 2013. 3. Severe acute malnutrition is defined by a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema. Mild protein-calorie malnutrition . Those regions include: 1. R63.6 . 2. Begin by selecting a report from the dropdown. hospice claim aligns with current coding guidelines, as well as, admission requirements for hospice certifications. The 2021 edition of ICD-10-CM E43 became effective on October 1, 2020. Protein malnutrition (kwashiorkor) Protein calorie malnutrition (marasmus) Develops over weeks: Develops over months: May not have weight loss: Significant weight loss: Due to systemic inflammation and semistarvation: Due to low intake of nutrients: Hypoalbuminemia: Serum albumin is normal: Excess body water: Edema is not a typical feature CC. E46 Unspecified . Bedridden or otherwise significantly reduced functional capacity. Dying does not equal a need for hospice. September 25, 2014. Old age and infirmity should not be an automatic hospice admission. I am not. The ICD-10 codes for malnutrition are as follows: E40 – Nutritional edema with dyspigmentation of skin and hair (kwashiokar should rarely be used in the U.S.) E42 – Severe protein-calorie malnutrition with signs of both kwashiorkor and marasmus. T73.0) Codes. 278.01 . The new criteria cannot distinguish among mild, moderate and severe malnutrition because, in the context of acute nutritional imbalance, these are meaningless terms. Phenotypic Criteria Etiologic Criteria Weight Loss (%) Low BMI (kg/m2) Reduced Muscle Mass Reduced Food Intake or Assimilation Inflammation >5% w/in past 6 mo or >10% beyond 6 mo <20 if <70 years or <22 if >70 years Marasmic kwashiorkor: this is mainly as a result of an intens… E66.01 . Protein-energy malnutrition : definition, epidemiology Protein-energy malnutrition is caused by an imbalance between intake and the body’s requirements. The acute respiratory failure and severe protein-calorie malnutrition would be listed as secondary diagnoses by the LIP in the final diagnostic statement and coded to … E46 Unspecified protein-calorie malnutrition. Severe Malnutrition <16.00 Moderate Malnutrition 16.00–16.99 Mild Malnutrition 17.00–18.49 Normal Range 18.50–24.99 Overweight >25.00 Pre-Obese 25.00–29.99 Obese >30.00 Obese Class I 30.00–34.99 Obese Class II 35.00–39.99 Obese Class III (Morbid Obesity) >40.00 ICD-9-CM4 • 262 Other severe, protein-calorie malnutrition and criteria used to identify its occurrence Only about 3% of patients admitted to acute care settings in the U.S. are diagnosed with malnutrition ICD-9-CM ICD-10-CM 262.0: Other severe protein-calorie malnutrition Refer to the Medical Policies page to access the hospice LCD. ventilation) and severe protein-calorie malnutrition (requiring the intervention of enteral nutrition). Protein-Calorie Malnutrition “ First degree ” Characterized by tissue wasting in an adult, but few or no biochemical changes. calorie malnutrition ICD-10-CM E46 Unspecified severe protein-calorie malnutrition 263.0 Malnutrition of moderate degree E44.0 Moderate protein-calorie malnutrition 263.1 Malnutrition of mild degree 263.8 Other protein-calorie malnutrition E44.1 Mild protein-calorie malnutrition 262 Other, severe protein-calorie malnutrition E43 Unspecified severe protein-calorie malnutrition New clinical guidelines for malnutrition could help alleviate compliance challenges associated with coding the condition, which has never had universally accepted clinical criteria. … Protein Calorie Malnutrition The patient meets all of the following (1,2, and 3): 1. The investigation only included malnourished children of primary etiology (low feeding). "Acute disease or injury-related malnutrition": inflammation is acute and of severe degree (e.g., major infection, burns, trauma or closed head injury) Jensen GL, Mirtallo J, Compher C, et al. " Healthcare Providers retain responsibility to submit complete and accurate documentation. I agree that hospice is now used when not necessary. Adult failure to thrive (AFTT) and debility are not to be used as the principal hospice diagnosis (ICD code) on the Medicare claim form." • Ongoing data collection efforts for possible future hospice refinements, including a case mix system for payment. Protein-Calorie Malnutrition For example, severe protein calorie malnutrition is a diagnosis that can be used for risk adjustment for several of the CMS quality programs, including mortality and readmission penalties, as well as some of the patient safety indicators. I got that out there, so now let’s talk some basic hospice 101. The “what, who, and where” details you need to know. Palliative Performance Scale equal to or less than 40% (mostly in bed, requires assistance with ADL) E43 Unspecified severe protein-calorie malnutrition. 3.1.2.2 Protein requirement with parenteral nutrition 20 3.1.2.3 Nutrition in the acute phase of disease 20 3.1.3 Micronutrients21 3.2 Exercise and health 26 3.2.1 Exercise for elderly 26 3.2.2 Exercise participation of elderly 26 3.2.3 Current physical activity guidelines 26 3.3 Treatment plan 26 … 3/2. Kwashiorkor: this is as a result of a deficiency in proteinwhich is often characterized by infiltration of the liver, oedema, dermatosis, stunting and wasting (which is low-height-for-age and low-weight-for-height respectively). Another problem is that ICD-9/10 codes, definitions and concepts have been based entirely on the classic criteria for chronic malnutrition. Norman K, Stobaus N, Gonzalez MC, Schulzke J-D, Pirlich M. Hand grip strength : Outcome predictor and marker of nutritional status. diagnostic criteria E44.0 Moderate. Protein-Calorie Malnutrition “ Second degree ” Characterized by superimposed biochemical changes in electrolytes, lipids, blood plasma. In the elderly, malnutrition causes or worsens a state of frailty and/or Personally, they are overused diagnoses. Notice that “malnutrition, unspecified,” “protein-calorie malnutrition,” and “protein-energy malnutrition” are all synonymous when it comes to actual codes. Morbid (severe) obesity due to excess calories . Unspecified protein-calorie malnutrition . Unspecified severe protein-calorie malnutrition. Code (s) that may be utilized in pediatric chart review are highlighted in pink. A minimum of 2 of the 6 characteristics above is recommended for diagnosis of either severe or moderate protein-calorie malnutrition. classification, and Nutritional Marasmus became diagnosis code E41. Clinical characteristics that the RD can obtain and document to support a diagnosis of malnutrition – Page 4 7. Also notice that several other codes are synonymous as well. Other Severe, Protein-Calorie Malnutrition and 263 (263–263.09) Other and Unspecified Protein-Calorie Malnutrition—and addi-tional code sets, also listed in the Endocrine, Nutritional and Metabolic, Immunity Section that relate to specific micronutri-ent deficits, may continue to be used in documenting observed adult nutrition deficits.27 General HHNurse<3. Coding professionals would use ICD-10-CM code E43 to report severe malnutrition, also known as starvation edema. Nutritional intake of < 50% of recommended intake for 2 weeks or more (as assessed by dietitian). Hospice Local Coverage Determination (LCD) LCDs provide guidance in determining medical necessity of services. We assessed protein-calorie nutritional status with Reilly's criteria and anthropometries. I’m hearing a lot of questions about whether someone with frailty, debility, or adult failure to thrive can still be admitted to hospice, especially since CMS will no longer beaccepting either debility or adult failure to thrive (AFTT) as a principal diagnosis on hospice claim forms starting on Oct. 1, 2014. If you are looking for a particular document then please use the MCD Search feature. The hospice principal diagnosis should list the the diagnosis that most contributes to a life expectancy of six months or less. iv Management of severe malnutrition: a manual for physicians and other senior health workers 5.4 Teaching parents how to prevent malnutrition from recurring 24 5.5 Preparation for discharge 24 Criteria for discharge 24 Appropriate diets 24 Immunization 25 Planning follow-up 25 6. 263.9. Hospice 101. The longer it is untreated, in fact, the higher the incidents of severe organ and tissue damage even in cases where malnutrition can be reversed. Type 1 excludes abnormal weight loss (R63.4), anorexia nervosa (F50.0-), and malnutrition … E46 . Pulmonary Disease Protein-calorie malnutrition can be a fatal condition if not properly detected and treated in its earliest stages. Applicable to malnutrition, not otherwise specified (NOS) Protein-calorie imbalance NOS . 10 Synthesis of prealbumin increases …