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

Ignacio Ruiz-García, Victoria Contreras-Bolívar, Francisco José Sánchez-Torralvo, Osmayda Ulloa-Díaz, María Ruiz-Vico, José Abuín-Fernández, Manuel Barrios-García, Emilio Alba-Conejo, Gabriel Olveira

Journal: Clinical nutrition (Edinburgh, Scotland) 2022;41(1):186-191

PMID: 34891021

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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 1,607,861.21€ and after revision it increased up to 1,799,199.69€, which means that 191,338.48€ were not reimbursed to the hospital due to the lack of coding of malnutrition. The cost reimbursement for each admission increased an average of 719.32€.

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.

Address: Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain. Electronic address: [email protected].; Servicio de Endocrinología y Nutrición, Hospital Universitario San Cecilio de Granada, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), Granada, Spain. Electronic address: [email protected].; Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain. Electronic address: [email protected].; Servicio de Documentación y Archivo de Historias Clínicas Del Hospital Regional Universitario de Málaga, Málaga, Spain. Electronic address: [email protected].; Universidad de Málaga, Málaga, Spain; Servicio de Oncología Médica, Hospital Regional Universitario de Málaga, Málaga, Spain. Electronic address: [email protected].; Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain. Electronic address: [email protected].; Servicio de Hematología y Hemoterapia, Hospital Regional Universitario de Málaga, Málaga, Spain. Electronic address: [email protected].; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain; Servicio de Oncología Médica, Hospital Regional Universitario de Málaga, Málaga, Spain. Electronic address: [email protected].; Servicio de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad de Málaga, Málaga, Spain; CIBERDEM (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: [email protected].

DOI: 10.1016/j.clnu.2021.11.028

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http://hdl.handle.net/10668/22111

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https://medlineplus.gov/malnutrition.html

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https://assays.cancer.gov/CPTAC-1617

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MeSH Terms: Clinical Coding, Cost-Benefit Analysis, Diagnosis-Related Groups, Female, Humans, Inpatients, Insurance, Health, Reimbursement, Male, Malnutrition, Middle Aged, Neoplasms, Nutrition Assessment, Patient Discharge, Prevalence, Prospective Studies