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Audit (A-03-13-00035)

01-28-2014
Christus Saint Vincent Regional Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

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Summary

Christus Saint Vincent Regional Medical Center, in Santa Fe, New Mexico, (the Hospital) did not comply with Medicare requirements for billing Kwashiorkor on any of the 115 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor, but should have used codes for other forms of malnutrition. For 86 of the inpatient claims, correcting the diagnosis code resulted in no change in the diagnosis-related group payment. However, for the remaining 29 inpatient claims, the errors resulted in overpayments of $147,000. Hospital officials attributed these errors to the medical coding software program used to code the diagnoses.

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