Re: Finally!!!! Medicare fraud ????

[Guest guest]

Well stated, Pam.

Ro

From: Weaver

Sent: Tuesday, March 01, 2011 11:52 PM

To: rd-usa

Subject: Re: Finally!!!! Medicare fraud ????

Yes, the Dx comes from doc and many go to coders now! Kwashiorkor may

not have been the best code for the coders to use but I do not think

they were being fraudulent! There is plenty of malnutrition any way

you code it:)

Sent from my iPhone

On Mar 1, 2011, at 10:50 PM, Pam Charney <mailto:pcharney%40mac.com> wrote:

> I thought we'd discussed this last week.

>

> The codes do not come from the MD. In most cases, while the provider

> is very aware of the ICD-9-CM term name, the code itself is not

> something they'd have memorized although those in some of the

> subspecialties might. Instead, in the inpatient setting, what happens

> is that when a patient is discharged, the medical record goes to the

> coders. The coders use software (or in the case of paper records, they

> use references) that looks for particular terms that allow them to

> affix an ICD code. There are various and complex rules and regulations

> regarding what can be coded, how many diagnoses can be " paid " , and how

> much each is paid. At the end of the day, they're looking for that

> magic mix of codes that give the highest reimbursement.

>

> As I've said before, Kwashiorkor is NOT a nutrition problem. We have

> got to get past the use of albumin as a nutrition marker. We'll never

> be able to prove our worth if we rely on something that has very

> little to do with nutrition and hope and keep our fingers crossed that

> it demonstrates the worth of the RD. I think we'd all agree that it

> takes much more than a serum albumin level to diagnose malnutrition.

> If you are crossing the street while eating a cheeseburger (or the

> high protein food of your dreams) and you've been eating fine, doing

> well, and all else is equal, have the bad luck to be hit by a bus, I

> can guarantee that your albumin will be somewhere around 3.0 the next

> morning. Are you malnourished? Absolutely not. Are you critically

> injured? Yes. Do you need to be seen by a highly skilled, well-trained

> nutrition support RD? Absolutely. But if you claim there's

> malnutrition at the get go, and the albumin doesn't go up until you're

> close to discharge, then you haven't demonstrated the worth of the RD.

>

> Take a look at a paper that I published in JADA in 2004 along with

> Fuhrman and Mueller; there we discuss the complexities of using

> hepatic transport proteins to assess nutrition status. Also, I've

> coauthored a Pocket Guide to Nutrition Assessment; we're in the second

> edition and looking at a revision soon. We have an expert author

> discussing use of labs. There is also a classic paper written by Gabay

> that was published in the New England Journal of Medicine in 1999;

> when I was teaching it was required reading for my students before

> they ever got to see a sick patient. It very nicely describes the

> acute phase response to illness and injury.

>

> While technically, one could code for kwashiorkor using current ICD

> definitions, remember the definition includes " dyspigmentation of the

> skin and hair " . Technically, you'd also have to find somewhere in the

> medical record a " severe " deficiency of protein. While I suppose one

> could argue that a sick patient didn't get enough protein, do we know

> how much and for how long? Do you want to be explaining this to the

> CMS folks when they figure out that it is statistically impossible to

> see the rate of kwashiorkor that some facilities are seeing because

> someone thought it would be the best way to determine how many

> patients are malnourished?

>

> I'm all for identifying and treating malnutrition where ever it may

> exist. However, I don't want to a) use the wrong tools to diagnose it

> and miss it when it really does exist. Remember, serum albumin

> remains normal until fairly late in starvation. Isn't that

> malnutrition?

>

> Regards,

> pam

>

> Pam Charney

> mailto:pcharney%40mac.com

>

>

>

>

>

>> The codes come from the Doctors; however, these hospitals pressure

>> docs to do procedures and Dx codes for best insurance reimbursement.

>> Most hospitals are always trying to stay one step ahead of Medicare!

>> Most are smart enough to document Dx codes and do not want to be

>> involved in fraud. I hope they have Nutrition Support RDs and a good

>> Medical Nutrition committee and QA committee. Most hospital's have

>> mostly malnourished critically ill patients that are what us older

>> RDs

>> would call ICU status. I hope ADA and other RDs write and Blog about

>> this story. I hope it brings attention to the malnourished patients

>> coming from nursing homes and elderly homes that do not have adequate

>> medical nutrition regulations and care by RDs.

>>

>> Sent from my iPhone

>>

>> On Mar 1, 2011, at 4:40 PM, hl brewer <mailto:hlbrewer%40yahoo.com> wrote:

>>

>>> Possible they are coding this dx based only on serum albumin (which

>>> we all know

>>> is NOT a good indication of protein status & so much more likely to

>>> be decreased

>>> in hospitalized patients if they have acute infectious process).

>>>

>>> Holly

>>>

>>> ----------

>>> Holly Lee Brewer, MS RD CDE

>>> Pediatric Dietitian, Diabetes Educator

>>> Medical Nutrition Therapist, Las Vegas, NV

>>>

>>> Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

>>> 301st MDS, NAS JRB Fort Worth (Carswell), TX

>>> Joint Base Balad, Iraq (Jan-Jul 2009)

>>>

>>> ________________________________

>>> From: Tina Marie <mailto:talk2tml%40yahoo.com>

>>> To: mailto:rd-usa%40yahoogroups.com

>>> Sent: Tue, March 1, 2011 12:53:42 PM

>>> Subject: Finally!!!! Medicare fraud ????

>>>

>>>

>>>

http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illn\

ess.html

>>>

>>> Tina Marie

>>>

>>>