Malnutrition identification, coding and costs

Ms Sarah Ryan1

1Bundoora, Australia, 2Professor Meg Morris, Bundoora, Australia

Aim: To assess the viability of conducting a pilot study to further investigate potential clinical and cost implications of current malnutrition identification, diagnosis and coding practices at a Healthscope Hospital.

Method: A small sample of General Medical patients admitted to a Healthscope Hospital with a diagnosis of malnutrition were analysed to determine whether there was an uplift to their Diagnostic Related Grouping (DRG) and the hospital reimbursement received as a result of having their malnutrition correctly identified, diagnosed and coded.

Results: Changes to the Diagnostic Related Grouping (DRG) and additional hospital reimbursement was generated by correct identification, diagnosis and coding in 18% of patients with malnutrition. There was an average additional hospital reimbursement of approximately $2,400 in patients that did have an uplift to their DRG.

The potential for a DRG uplift in patients diagnosed with malnutrition in a private hospital setting is dependent on several factors including their hospital health fund contract, primary admission reason and co-morbidities. This case study indicates that a pilot study further investigating clinical and cost implications of current malnutrition-related practices in this setting is viable.

Significance of the findings to Allied Health: Hospital patients identified as being at risk of malnutrition should be promptly referred to an Accredited Practising Dietitian for a thorough nutrition assessment, diagnosis and commencement of a nutrition management plan. Further research into the clinical and cost outcomes of nutrition-related practices in a Healthscope Hospital will contribute to our understanding of how dietitians can work as an effective part of the multidisciplinary workforce to improve patient outcomes in private hospitals.