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The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.

Coding, coverage, and reimbursement are vital to the clinical segment of our profession. The objective of this study was to assess understanding and use of the medical nutrition therapy (MNT) procedure codes. Its design was a targeted, cross-sectional, Internet survey. Participants were registered dietitians (RDs) preselected based on Medicare Part B provider status, randomly selected RDs from the American Dietetic Association database based on clinical practice designation, and self-selected RDs. Parameters assessed were knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use/compensation, need for additional codes for existing/emerging services, and practice demographics. Results suggest that MNT is being reimbursed for a variety of diseases and conditions. Many RDs working in clinic settings are undereducated about code use of any kind, reporting that code selection frequently is determined not by the RD providing the service, but by "someone else." Self-employed RDs are less likely to rely on others to administrate paperwork required for reimbursement, including selection of procedure codes for billable nutrition services. Self-employed RDs are more likely to be reimbursed by private or commercial payers and RDs working in clinic settings are more likely to be reimbursed by Medicare; however, the proportion of Medicare providers in both groups is high. RDs must be knowledgeable and accountable for both the business and clinical side of their nutrition practices; using correct codes and following payers' claims processing policies and procedures. This survey and analysis is a first step in understanding the complex web of relationships between clinical practice, MNT code use, and reimbursement.

Older Americans experience chronic disease at rates well above other segments of our society. Rates of health services use are also 2 to 3 times that of younger age groups. The most rapidly growing segments of America's aging population are also its most nutritionally vulnerable-women, minorities, and those 85 years of age and older. The routine incorporation of nutrition screening and intervention into chronic disease management protocols will lower healthcare services usage, decrease healthcare costs, help relieve the burden of human suffering experienced by older Americans with chronic disease, and improve quality of life for our nation's elders.

The American Gastroenterological Association acknowledges the need for gastroenterologists to participate in and provide value-based care for both cognitive and procedural conditions. Episodes of care are designed to engage specialists in the movement toward fee for value, while facilitating improved outcomes and patient experience and a reduction in unnecessary services and overall costs. The episode of care model puts the patient at the center of all activity related to their particular diagnosis, procedure, or health care event, rather than on a physician's specific services. It encourages and incents communication, collaboration, and coordination across the full continuum of care and creates accountability for the patient's entire experience and outcome. This paper outlines a collaborative approach involving multiple stakeholders for gastrointestinal practices to assess their ability to participate in and implement an episode of care for obesity and understand the essentials of coding and billing for these services.

The Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight-for-height/length, body mass index-for-age, or length/height-for-age or mid-upper arm circumference when a single data point is available. When 2 or more data points are available, indicators may also include weight gain velocity (

Coding, coverage, and reimbursement for nutrition services are vital to the dietetics profession, particularly to registered dietitian nutritionists (RDNs) who provide clinical care. The objective of this study was to assess RDN understanding and use of the medical nutrition therapy (MNT) procedure codes in the delivery of nutrition services. Its design was an Internet survey of all RDNs listed in the Academy of Nutrition and Dietetics (Academy)/Commission on Dietetics Registration database as of September 2013 who resided in the United States and were not retired. Prior coding and coverage surveys provided a basis for survey development. Parameters assessed included knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use, payer reimbursement patterns, complexity of the patient population served, time spent in the delivery of initial and subsequent care, and practice demographics and management. Results show that a majority of respondents were employed by another and provided outpatient MNT services on a part-time basis. MNT codes were used for the provision of individual services, with minimal use of the MNT codes for group services and subsequent care. The typical patient carries two or more diagnoses. The majority of RDNs uses internal billing departments and support staff in their practices. The payer mix is predominantly Medicare and private/commercial insurance. Managers and manager/providers were more likely than providers to carry malpractice insurance. Results point to the need for further education regarding the full spectrum of Current Procedural Terminology codes available for RDN use and the business side of ambulatory MNT practice, including the need to carry malpractice insurance. This survey is part of continuing Academy efforts to understand the complex web of relationships among clinical practice, coverage, MNT code use, and reimbursement so as to further support nutrition services codes revision and/or expansion.

Although a direct correlation between poor nutrition status and increased risk of readmission has yet to be established, it is reasonable to assume that patients who are identified as undernourished while hospitalized would be "at increased risk of adverse outcomes" following discharge. Also, the evidence that links nonadherence to dietary prescriptions after discharge, with increased readmissions in patients with heart failure (HF), is fairly robust. Nutrition screening prior to discharge should be mandated, just as it is at admission. However, the criteria to assess a patient's ability to adequately and appropriately nourish themselves after discharge are very different from those used to diagnose and treat malnutrition on admission or during a hospital stay. The U.S. healthcare environment germane to the readmissions rates policy that was adopted for implementation in October 2012 by the Centers for MedicareMedicaid Services is characterized. Factors critical to the successful development and implementation of a post-acute nutrition care plan are described. Nutrition-related contributors to readmissions in HF are delineated. Transitional care models that could be adapted to enhance nutrition care plan efficacy are identified, as is the need to adopt a multidisciplinary approach to nutrition in transitional care that includes care coordination and routine follow-up. An evidence-based systematic approach to determine those patients in whom palliative vs restorative nutrition care is appropriate needs to be developed.

A history of the goals, activities, and accomplishments of the Nutrition Screening Initiative (NSI) is provided. A commentary on the development and intended use of the NSI's self-assessment and screening tools is given to facilitate selection of feeding devices for older Americans who need nutrition care. Additional questionnaires and interventions designed to address the needs identified through the NSI's standardized, interdisciplinary approach to the assessment of nutritional risk are described and their use encouraged. Legislative and public policy advocacy is summarized. A systemic approach to the assessment and maintenance of optimal nutritional health in the older population will have a profound effect on health care delivery systems.

T HE PROVISION OF CLINICAL nutrition services is a core activity within the profession of dietetics. It isnotonlythedietetics practitioners who provide the clinical nutrition service that must understand and comply with sound business and ethical billing practices; those who provide one or more of the myriad of food, administrative, community, education, and/or research components that support and augment reimbursable services, includingbillers, mustalsoknowandadheretotheelementsof ethical billing across the continuum of both practice management and the delivery of clinical nutrition care (1) (Codeof Ethics Principles 1, 2, 4). The Code of Ethics is designed to ensure competent, values-based practice (1). It should not be used to resolve business or practice disputes between dietetics practitioners, other health care providers, and/or consumers (2). Poor business practices are associated with the multiple “losses”: loss of brandandprofessional reputation, loss of customers, employees, revenue, and in the end, loss of thebusiness itself. Business/contract disputes are not automatically Code of Ethics violations, but may often result from poor business practices, unprofessional be

The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment, and further ensure the provision of high quality, cost effective nutritional care.

Nutrition risk can be assessed in elderly populations by evaluating such factors as food intake, income, functional status, socialization, acute and chronic illness, and use of medications. Nutrition screening must become an integral component of the health care services provided for all older Americans. Nutrition screening and early intervention are primary steps in the development of a system of health care that is affordable and accessible to all.

The 1991 Consensus Conference of the Nutrition Screening Initiative (NSI), Nutrition Screening I: Toward a Common View, has led to increased professional awareness of poor nutritional status and better definitions and standards for identification of risk factors and indicators of poor nutritional status in older Americans. Characteristics by which risk factors of poor status are to be recognized and indicators for subsequent assessment have been described. A conceptual framework for a public awareness checklist was agreed upon, and preliminary drafts of basic screening instruments were reviewed. Since the consensus conference, much has been accomplished in terms of format, sequence, language, presentation style, and weighting of data elements contained in the public awareness checklist and the screening tools. This discussion provides a brief overview of their development and recommendations for their appropriate use.

Dietetics professionals must become even more proactive in taking the lead in the nutritional screening and assessment of older Americans. They can do so by encouraging all health care providers to become familiar with each older American's circumstances and needs. In addition, as individuals and as a professional health care association, we should urge our colleagues and institutions to establish regular longitudinal surveillance and continuity of care in nutrition services delivery. The timely, appropriate, and cost-effective delivery of nutritional screening, assessment, and care will improve the health and well-being of this valued segment of the US population. Dietetics professionals are a vital part of this process.

Malnutrition in older Americans involves many disparate and complex causes. Dietetics professionals need to broaden their scope of practice in dealing with nutrition screening and intervention themselves and in providing expert consultation to others. Health and social services generalists such as physicians, nurses, and social workers must become more aware of the presence and risk of nutrition-related problems in the elderly and must adopt a systematic, collaborative approach to their solution. Nutrition screening, intervention, appropriate referral, and consultation must be built into daily practice. The NSI is a challenge and a call to action for all dietetics professionals. Registered dietitians must become active participants on interdisciplinary teams. They must assume a leadership role in areas of nutrition screening, assessment, and intervention. Their knowledge, skills, and expertise must continue to keep pace not only with advances in the science and technology of nutrition but also with relevant areas of related fields. The tools provided by the NSI and partnerships between nutrition and other health and social services professionals provide opportunity for the widespread incorporation of a systematic approach to delivery of nutrition services. Attention to nutritional health is too important to be left solely to health specialists or to generalists; all must become active participants in maximizing the nutritional health of older Americans.

The American Diabetes Association (ADA) position statement titled “Nutrition Recommendations and Principles for People with Diabetes Mellitus”1 was developed to offer guidance for people able to live independently and who have the functional, emotional, cognitive, and economic resources necessary to meet their basic nutritional needs. The ADA position statement titled “Translation of the Diabetes Nutrition Recommendations for Health Care Institutions,”2 which is reprinted in this issue (p. 39), and its accompanying technical review3 were initially published in 1997,4 and the statement has been only slightly modified since then. This translation document accurately reflects the fact that the bulk of diabetes teaching now occurs in ambulatory care settings, the increased severity and complexity of illness that patients with diabetes bring to the hospital on admission, and their increasingly shorter lengths of stay. The importance of basic nutrition education of all health professionals involved in diabetes management cannot be overemphasized. The discussion of special nutrition issues provides a brief overview of recommendations related to liquid diets, diets post-surgery and in patients who experience catabolic stress, and parenteral and enteral support. Additional issues that the position statement …