Cox Medical Center Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor

Cox Medical Center (the Hospital), in Branson, Missouri, did not comply with Medicare requirements for billing Kwashiorkor on any of the 59 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition or no malnutrition code at all. For 21 of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the payment amount. However, for the remaining 38 inpatient claims, the errors resulted in overpayments of $123,000. Hospital officials attributed these errors to problems with the software used to code the diagnoses.