The economic cost of not coding disease-related malnutrition: A study in cancer inpatients

Abstract

Background & aims: Disease-related malnutrition (DRM) coding rate is usually low in hospitalised patients. The objective of our study was to estimate the percentage of correct DRM coding in cancer inpatients and to calculate the economic losses caused by such lack of coding. Methods: This was an observational, prospective study that was conducted in patients hospitalised in the Medical Oncology Unit of our hospital. A nutritional assessment was performed through subjective global assessment (SGA). The all patient refined-diagnosis related group (APR-DRG) weights were obtained at the moment of discharge; moreover, recalculation was done after including the diagnosis of malnutrition in the medical record of those patients in whom it had not been initially coded. The associated cost reimbursement were calculated based on the weight before and after revising the diagnosis of DRM. Results: A total of 266 patients were evaluated. From them, 220 (82.7%) suffered from DRM according to the SGA. In 137 (51.5%) of these patients, diagnosis was coded, as opposed to 83 (31.2%) cases (33 subjects with moderate and 50 with severe DRM) in whom it was not coded. The sum of the APR-DRG weights before revising the diagnosis of malnutrition was 343.4 points (mean: 1.29 ± 0.89). Whereas, after revising the diagnosis, it increased up to 384.3 (1.44 ± 0.96). The total cost reimbursement for the hospital before revising the diagnosis of malnutrition was 1,607,861.21V and after revision it increased up to 1,799,199.69V, which means that 191,338.48V were not reimbursed to the hospital due to the lack of coding of malnutrition. The cost reimbursement for each admission increased an average of 719.32V. Conclusion:The prevalence of DRM in cancer inpatients is high. Nevertheless, the diagnosis is not coded in one third of patients, which results in important economic losses for the hospitals.

Nutritional support during the hospital stay is cost-effective for preventing adverse outcomes in patients with cancer

“…Further, despite high rates of malnutrition in hospitalized patients, a recent report noted that malnutrition diagnoses were not coded in at least one-third of cases, thus leading to lost reimbursements for hospital care ( 28 ).…”

Evaluation of Nutritional Interventions in the Care Plan for Cancer Patients: The NOA Project

“…Malnutrition is a common medical condition in cancer patients [ 1 , 2 ]. It has negative consequences on the course of the disease in terms of quality of life and life expectancy [ 3 , 4 , 5 , 6 , 7 ], as well as on the use of healthcare resources associated with treatment [ 8 , 9 ].…”