Monday, February 26, 2018

Coding Emaciation in Adult Patients

A physician documents emaciation for a 72-year-old female patient.  Using the ICD-10-CM index, you are led to code E41, should you assign it?  The short answer is no, and this installment of “In the kNOW” will explore the rationale for that answer. 

E41 is the code for nutritional marasmus or severe malnutrition with marasmus.  Further information provided under the code tells us that marasmus is a type of protein-calorie malnutrition in children.  Since our patient is 72-years-old, this code would not apply.  So what now?  How should we code emaciation in adult patients?

3rd Qtr. 2017 Coding Clinic (pages 24-26) states that if the physician documents emaciation, the proper code to be assigned is R64 for cachexia or wasting.  The rationale provided for this code assignment is that emaciation means extremely thin due to wasting.  The provider should clearly document malnutrition if that is what he or she meant, but again, E41 would not be appropriate for an adult.  Rather, codes E43-E46, as appropriate, would be assigned for malnutrition status.  Remember that E40 (Kwashiokor) and E42 (Marasmic kwashiorkor) are forms of severe malnutrition usually found in underdeveloped countries and likely not applicable for our coding in the U.S.  The Index will guide coders to E43 for severe malnutrition, by finding Malnutrition, degree, severe.

The same Coding Clinic reminds coders that as a basic coding rule, if the title of the code that is suggested by the Index is not seeming to identify the condition correctly, more research will be required in order to assign the appropriate code.  This may necessitate research into the condition, use of coding resources such as Coding Clinic, or querying the physician. 

Now you are in the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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