Jefferson Hospital Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Jefferson Hospital (the Hospital), in Jefferson City, Pennsylvania, did not comply with Medicare requirements for billing Kwashiorkor on any of the 46 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition or no malnutrition code at all. For one of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the diagnosis-related group payment amount. However, for the remaining 45 inpatient claims, the errors resulted in overpayments of $185,000. Hospital officials attributed these errors to a misinterpretation of the coding guidelines.