Webinar Roundup: Malnutrition At-A-Glance Coding and Denials

To determine and identify whether patients are at-risk of malnutrition, healthcare physicians and medical coders must have an efficient way of communicating all patient documentation and treatments to one another. In our most recent Webinar Roundup: Malnutrition At-A-Glance Coding and Denials, Marie Thomas, ECLAT Senior Director, Coding and HIM Operations, Evelyn Santos, ECLAT Coding and Audit Specialist, and Guest Contributor, Clinical Nutrition Manager (RDN) at Health Central Hospital, and Arelys Villafane helped listeners explore malnutrition clinical indicators and the many ways medical coders can increase accuracy, tools to use to properly identify malnutrition, and how to avoid the denials that commonly occur.

ECLAT Health Solutions cares to provide detail-oriented clinical documentation improvement services at your convenience to allow you and your team to thrive at providing quality healthcare experiences. Here’s an overview of what was discussed between Marie and Evelyn, in our latest Webinar Roundup: Malnutrition At-A-Glance Coding and Denials.

The Clinical Perspective

With Arelys Villafane’s expert contributions, Marie spoke in length about how previously in the clinical field, malnutrition was “once thought of as not having adequate sustenance for consumption to maintain proper health. For instance, in third world countries.” When in fact, malnutrition is an acute, subacute or chronic state of nutrition in which a combination of varying degrees of overnutrition or undernutrition with or without inflammatory activity has led to a change in body composition and diminished function. While it’s also a common problem in hospital patients that often goes unrecognized, undiagnosed, and untreated, research has shown that malnutrition occurs in 30-55% of hospital patients and leads to significant negative outcomes.

Marie explained to the Webinar Roundup: Malnutrition At-A-Glance Coding and Denials attendees that research also shows us that early nutrition interventions can improve health outcomes, mobility, mortality, and reduce the length of stay in hospital patients. One proactive way to catch malnutrition indicators is by screening patients using a validated screening tool such as the Malnutrition Screening Tool (MST) upon admission. This helps improve early identification of patients at risk of malnutrition to facilitate early nutrition interventions.

A malnutrition project had taken place to investigate the accuracy of malnutrition documentation and coding to calculate both capture and missed reimbursement. Arelys’ notes state:

  • As a result, an average of 56% of patients identified as malnourished by the dietitian were coded with a malnutrition diagnosis. Missed opportunities of diagnosing at-risk patients occurred due to a lack of physician documentation.
  • RDN driven reimbursement for FY 2018 = $280,774.63. Malnutrition diagnosis as the only CC or MCC that increased reimbursement for a specific  DRG and not including insurance denials.
  • Missed reimbursement opportunities for FY 2018 = 238, 239.17. This represents patients w/o a malnutrition diagnosis code that had the potential to be the only driven of increased reimbursement.

The Medical Coding Perspective

When it comes to coding at-risk malnutrition-patients, Marie stated that “coders are unable to code from anyone other than the physician or provider.” To make this information more widely available to coders, she recommended that the patient must be properly screened and identified as an at-risk patient through a Nutrition Assessment Form meeting at least two or more of the criteria. Once the patient has been identified, the documentation goes to the CDI team, in which the CDI team works with the physician to solidify a complete diagnosis. After the documentation has been evaluated by the CDI professionals and the physician, it goes right back to the chart and is saved in the patient’s records.

As the webinar progressed, Evelyn would pose frequently asked questions like “in order to understand clinical indicators for malnutrition, what guidelines should hospitals and staff follow?” Marie then discussed malnutrition indicator tips, when and how to appropriately query a physician, and why following a strict criteria is important in documentation and coding malnutrition. To learn more about proper documentation and coding malnutrition, watch our Webinar Roundup: Malnutrition At-A-Glance Coding and Denials today!

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ECLAT Health Solutions understands the importance of ongoing education for sustained quality, regardless of whether you are a physician, medical coder, auditor, CDI Professional or HIM Professional. That is why every quarter, ECLAT Health Solutions provides valuable educational content to our subscribers, such as best practices for clinical documentation improvement or denial avoidance, through our free educational webinar series – ‘Experience The Brilliance’. Whether you are looking to enhance your medical coding skills with refreshing tips from our long-time experts, or you wish to hear from a physician’s perspective on frequently asked questions in the workplace, our team is always looking to share more insight tailored to our audience requests.  

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For more questions, contact Marie Thomas at, or contact us today at (703) 665-4499.

Webinar Roundup: Exploring Respiratory Failure from a Clinical Perspective

As revenue cycle management, medical coding, and clinical documentation improvement professionals, the topic of acute and chronic respiratory failure is something that comes across our clients’ screens regularly. It is a very unique health issue that many don’t fully understand, and that can be difficult to document. Because of its distinctive properties, and popular audience request, we felt it was a topic that needed some discussion. That is why we chose this quarter’s webinar topic from our “Experience the Brilliance” webinar series to explore respiratory failure from a clinical perspective. Joined by ECLAT’s Senior Director of Coding and HIM Operations, Marie Thomas, and clinical care physician, Krishna Thandra, MD, we discussed the basics of respiratory failure, how it is viewed from a clinical perspective, and how to identify and document it from a medical coding perspective.

2018-07-31 13.00 Exploring Respiratory Failure – A Clinical Perspective from Giovanna Govea on Vimeo.

Exploring Respiratory Failure – A Clinical Perspective from Giovanna Govea on Vimeo.

The Clinical Perspective

First, the MC of the webinar, Giovanna Govea of ECLAT Health Solutions, defined respiratory failure before introducing Dr. Krishna Thandra to offer a clinical perspective. According to the late Robert S. Gold, MD, “respiratory failure basically means that the lungs cannot meet the needs of the body to supply oxygen and remove carbon dioxide.” In clinical trials, signs of respiratory failure include increased respiratory rate, increased burden of oxygen, decreased oxygen levels, and increased carbon dioxide levels.

When someone experiences respiratory failure, there are some key physiological changes that occur:

  1. Impacts the heart because of the lower oxygen level
  2. Cor pulmonale may occur with right sided heart enlargement
  3. Liver may become enlarged/engorged, swelling of LE or UE, irregular rhythm
  4. Risk of blood clots

As Dr. Thandra discussed,

The Medical Coding Perspective

Identifying respiratory failure quickly and properly is imperative to a patient’s health. After respiratory failure is identified by a physician, the clinical documentation is the next important step in the process. The clinical perspective helps us to better distinguish clinical criteria for acute vs. chronic respiratory failure, and to identify the correct medical coding assignment for respiratory failure cases. There are 3 important sets of criteria for identifying acute respiratory failure, as outlined in the webinar by Marie Thomas, Senior Director of Coding and HIM Operations, all of which can be found on pages 7-9 of the webinar handout. It is important to look closely at these criteria, as some distinctions are vital to identify in order to document the condition properly.

What happens if a patient is admitted with respiratory failure and another acute condition? The principal diagnosis depends on the individual patient’s situation and what caused the admission of the patient to the hospital. This coding guideline applies regardless of whether the other acute condition is a respiratory or non-respiratory condition. If the documentation is unclear, the physician should clarify which of the two conditions was the reason for admission. In some cases, both conditions may be equally responsible for the admission, just make sure that the severity of illness and intensity of service are equivalent for both.

Case Study and Poll

After reviewing respiratory failure from clinical and coding perspectives, Marie walked the webinar attendees through a case study followed by a question. To view the case study and see if the audience answered correctly, be sure to watch the webinar replay and review the webinar handout. Feel free to let us know what you think the answer is by commenting below.

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Our “Experience the Brilliance” Webinar Series is meant to provide educational insight to medical coders, CDI professionals, and HIM professionals for FREE on a quarterly basis, so be sure to join us next time! Follow ECLAT on LinkedIn for updates on future webinars and industry-related news.