Baptist Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Baptist Medical Center (the Hospital), in San Antonio, Texas, did not comply with Medicare requirements for billing Kwashiorkor on any of the 102 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used either a code for another form of malnutrition or no malnutrition code at all. As part of its own review, the Hospital identified four additional claims that it had incorrectly billed with diagnosis code 260. These errors resulted in overpayments totaling approximately $478,000: $459,000 identified in our review and $19,000 identified by the Hospital. Hospital officials attributed these errors to a lack of understanding of the clinical guidelines for coding Kwashiorkor and to potentially confusing direction from the ICD-9-CM coding books.