Report Materials
Christus Saint Vincent Regional Medical Center, in Santa Fe, New Mexico, (the Hospital) did not comply with Medicare requirements for billing Kwashiorkor on any of the 115 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor, but should have used codes for other forms of malnutrition. For 86 of the inpatient claims, correcting the diagnosis code resulted in no change in the diagnosis-related group payment. However, for the remaining 29 inpatient claims, the errors resulted in overpayments of $147,000. Hospital officials attributed these errors to the medical coding software program used to code the diagnoses.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.