DRG & Nutrition

The number of inpatient cases in the respective cantons was analysed, as well as the number of cases coded as energy and protein malnutrition (E44.1, E44.0, E43, E46), cachexia (R64) or sarcopenia (M62.5-). The number of nutrition therapy CHOP codes coded was also analysed.

The number of coded malnutrition diagnoses (E43, E44.0, E44.1, E46) is steadily increasing:

• 2012 = 1.1 %
• 2013 = 1.6 %
• 2014 = 2.2 %
• 2015 = 2.9 %
• 2016 = 3.4 %
• 2017 = 3.9 %
• 2018 = 5.7 %
• 2019 = 5.1 %
• 2020 = 5.9 %
• 2021 = 6.0 %
• 2022 = 6.3 %

Practical relevance of the non-specific code E46
Unfortunately, the unspecific code (E46) was again coded very often in 2022. This code was used in 25% of all cases with a coded malnutrition diagnosis. This occurs when the required criteria of the coding guideline were not met, such as the NRS not being shown and/or the nutritional therapy not being documented and/or only one nutritional therapy service being provided and/or the required documentation not being available to the coding department. This code has also no longer been relevant to revenue since 2015. The GESKES/SVDE DRG and Nutrition Working Group once again recommends that internal statistics be requested in your own hospitals. If the proportion of E46 is high, it is urgently recommended that the internal processes be evaluated, e.g. consistent implementation of screening using NRS-2002 and the availability of documentation of nutritional therapy with the required criteria to the coding department.

In psychiatric clinics, too, it is important to identify and treat malnutrition in accordance with professional criteria. It can also be cost-relevant here in certain cases.

Cachexia:
2015 = 0.25 %
2016 = 0.17 %
2017 = 0.18 %
2018 = 0.15 %
2019 = 0.15 %
2020 = 0.14 %
2021 = 0.12 %
2022 = 0.13 %

Sarcopenia:
2018 = 0.24 %
2019 = 0.35 %
2020 = 0.51 %
2021 = 0.57 %
2022 = 1.02 %