Methodist Hospital Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Methodist Hospital (the Hospital), in San Antonio, Texas, did not comply with Medicare requirements for billing Kwashiorkor on any of the 124 claims that we reviewed, resulting in overpayments of $440,000. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed either other forms of malnutrition or no malnutrition at all. Hospital officials attributed these errors to a lack of clarity in the coding guidelines and issues with the medical coding software program used to code the diagnoses.