Mount Sinai Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Mount Sinai Medical Center (the Hospital), in New York, New York, did not comply with Medicare requirements for billing Kwashiorkor on any of the 35 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition. For 32 of the inpatient claims, correcting the diagnosis code resulted in no change in the payment. However, for the remaining three inpatient claims, the errors resulted in overpayments of $11,000. Hospital officials attributed these errors to a misinterpretation of the coding guidelines by their coding staff.