Providers incorrectly billed for Kwashiorkor, a type of severe protein malnutrition, 99 percent of the time, according to HHS' Office of Inspector General.
A review of 2,145 inpatient claims across 25 providers revealed one claim correctly used the diagnosis code for Kwashiorkor, 260. The incorrect claims resulted in overpayments of more than $6 million for patients who did not have the disease, according to OIG.
The incorrect coding stems from a discrepancy between ICD-CM's tabular list and its alpha index. The alpha index contained four other malnutrition diagnoses that fell under code 260, while the tabular list only listed Kwashiorkor as the appropriate diagnosis for code 260.
While OIG's review successfully returned $5.7 million to Medicare, the agency estimates Medicare lost about $102 million between 2006 and 2014 due to the discrepancy. Although CMS was aware of the issue, it did not address it, according to the report.
This year, CMS asked the American Hospital Association to publish additional coding guidance on the Kwashiorkor diagnosis code.
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