Malnutrition should be diagnosed when 2 or more of the following 6 criteria are identified:
1. Insufficient Energy Intake
2. Weight Loss
3. Loss of Muscle Mass
4. Loss of Subcutaneous Fat
5. Localized or generalized fluid accumulation that may sometimes mask weight loss
6. Diminished functional status as measured by hand grip strength
Note: ALBUMIN and PREALBUMIN are not criteria
• The diagnosis of Malnutrition is under very high scrutiny from the government. We are asking physicians to document the diagnosis when clinically appropriate as well as:
- How did the diagnosis affect the care of your patient?
▪ Risks that your patient may face due to the diagnosis
- What interventions did you take to address the issue?
▪ Nutrition consult
▪ Supplements and/or special dietary issues
- Document effectively on the DC summary
▪ Very important to carry the diagnosis to the DC summary
▪ Include explicit detail supporting the diagnosis
Download the complete tip, Malnutrition: Increased Scrutiny.