Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-12-01T02:33:17.708Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital-Acquired Catheter-Associated Urinary Tract Infection: Documentation and Coding Issues May Reduce Financial Impact of Medicare's New Payment Policy

Published online by Cambridge University Press:  02 January 2015

Jennifer Meddings ,
Sanjay Saint  and
Laurence F. McMahon Jr
Jennifer Meddings*
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
Laurence F. McMahon Jr
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
*
300 North Ingalls Building, Room 7D-10, Ann Arbor, Michigan 48109, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

To evaluate whether hospital-acquired catheter-associated urinary tract infections (CA-UTIs) are accurately documented in discharge records with the use of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes so that nonpayment is triggered, as mandated by the Centers for Medicare and Medicaid Services (CMS) Hospital-Acquired Conditions Initiative.

Methods.

We conducted a retrospective medical record review of 80 randomly selected adult discharges from May 2006 through September 2007 from the University of Michigan Health System (UMHS) with secondary-diagnosis urinary tract infections (UTIs). One physician-abstractor reviewed each record to categorize UTIs as catheter associated and/or hospital acquired; these results (considered “gold standard”) were compared with diagnosis codes assigned by hospital coders. Annual use of the catheter association code (996.64) by UMHS coders was compared with state and US rates by using Healthcare Cost and Utilization Project data.

Results.

Patient mean age was 58 years; 56 (70%) were women; median length of hospital stay was 6 days; 50 patients (62%) used urinary catheters during hospitalization. Hospital coders had listed 20 secondary-diagnosis UTIs (25%) as hospital acquired, whereas physician-abstractors indicated that 37 (46%) were hospital acquired. Hospital coders had identified no CA-UTIs (code 996.64 was never used), whereas physician-abstractors identified 36 CA-UTIs (45%; 28 hospital acquired and 8 present on admission). Catheter use often was evident only from nursing notes, which, unlike physician notes, cannot be used by coders to assign discharge codes. State and US annual rates of 996.64 coding (~1% of secondary-diagnosis UTIs) were similar to those at UMHS.

Conclusions.

Hospital coders rarely use the catheter association code needed to identify CA-UTI among secondary-diagnosis UTIs. Coders often listed a UTI as present on admission, although the medical record indicated that it was hospital acquired. Because coding of hospital-acquired CA-UTI seems to be fraught with error, nonpayment according to CMS policy may not reliably occur.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 6 , June 2010 , pp. 627 - 633
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Federal Regist 2007;72(162): 47129–48175.Google Scholar
2.Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates. Federal Regist 2008;73(161): 48473–48491.Google Scholar
3.Phipps, S, Lim, YN, McClinton, S, Barry, C, Rane, A, N'Dow, J. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database Syst Rev 2006(2):CD004374.Google Scholar
4.Niel-Weise, BS, van den Broek, PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev 2005(3): CD004203.Google Scholar
5.Jain, P, Parada, JP, David, A, Smith, LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995; 155(13):1425–1429.CrossRefGoogle ScholarPubMed
6.Fernandez, R, Griffiths, R. Removal of short-term indwelling urethral catheters. Joanna Briggs Inst Best Pratt Tech Rep 2006;2(3):1–32.Google Scholar
7.Dunn, S, Pretty, L, Reid, H, Evans, D. Management of short term indwelling urethral catheters to prevent urinary tract infections: a systematic review. Joanna Briggs Inst 2000;6:1–64.Google Scholar
8.Wong, ES. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 1983;11(1:28–36.CrossRefGoogle ScholarPubMed
9.Warren, JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am 1997;11(3):609–622.CrossRefGoogle ScholarPubMed
10.Stamm, WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 1991;91(3B):65S–71S.CrossRefGoogle ScholarPubMed
11.Smith, JM. Indwelling catheter management: from habit-based to evidence-based practice. Ostomy Wound Manage 2003;49(12:34–45.Google ScholarPubMed
12.Yokoe, DS, Mermel, LA, Anderson, DJ, et al.A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S12–S21.CrossRefGoogle ScholarPubMed
13.Lo, E, NicoUe, L, Classen, D, et al.Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S41–S50.Google Scholar
14.Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, D; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009. Centers for Disease Control and Prevention Web site, http://www.cdc.gov/ncidod/dhqp/dpac_uti_pc.html. Published 2008. Accessed November 10, 2009.Google Scholar
15.Foxman, B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002;113(suppl 1A):5S–13S.Google Scholar
16.Saint, S, Wiese, J, Amory, JK, et al.Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109(6:476–480.CrossRefGoogle ScholarPubMed
17.Fakih, MG, Dueweke, C, Meisner, S, et al.Effect of nurse-led multidis-ciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol 2008;29(9): 815–819.Google Scholar
18.Saint, S, Meddings, JA, Calfee, D, Kowalski, CP, Krein, SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 2009;150(12:877–884.CrossRefGoogle ScholarPubMed
19.Coffey, R, Milenkovic, M, Andrews, R. The case for the present-on-admission (POA) indicator. Healthcare Cost and Utilization Project Web site, http://www.hcup-us.ahrq.gov/reports/methods.jsp. Published 2006. Accessed June 1, 2008.Google Scholar
20.Present on admission (POA) indicator reporting by acute inpatient prospective payment system (IPPS) hospitals. Centers for Medicare and Medicaid Services Web site. http://www.cms.hhs.gov/HospitalAcqCond/Downloads/POAFactsheet.pdf. Published October 2008. Accessed November 10, 2009.Google Scholar
21.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5:309–332.Google Scholar
22.Catheter-associated urinary tract infection (CAUTI) event. In: CDC Division of Healthcare Quality Promotion, ed. The National Healthcare Safety Network (NHSN) Manual. http://www.cdc.gov/nhsn/pdfs/pscManual/7pscCAUTIcurrent.pdf. Published 2009. Accessed April 25, 2010.Google Scholar
23.Jarvis, WR. Benchmarking for prevention: the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) system experience. Infection 2003;31(suppl 2):44–48.Google Scholar
24.Braunwald, E, Fauci, A, Kaspar, D, Hauser, S, Longo, D, Jameson, J, eds. Harrison's Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2001.Google Scholar
25.Hooton, TM. Urinary tract infection. In: Wachter, RM, Goldman, L, Hollander, H, eds. Hospital Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005.Google Scholar
26.McPhee, SJ, Papadakis, MA, eds. Current Medical Diagnosis and Treatment. 48th ed. New York, NY: McGraw-Hill/Lange, 2009.Google Scholar
27.Passaretti, A, Ardehali, H, Nuermberger, E. Urinary tract infections. In: Nilsson, KR, Piccini, JP, eds. The Osier Medical Handbook. 2nd ed. Philadelphia, PA: Saunders Elsevier, 2006.Google Scholar
28. Centers for Medicare and Medicaid Services; National Center for Health Statistics. ICD-9-CM official guidelines for coding and reporting. Effective October 1, 2009. National Center for Health Statistics Web site. http://www.cdc.gov/nchs/data/icd9/icdguide09.pdf. Published August 31, 2009. Accessed November 10, 2009.Google Scholar
29.Maki, DG, Tambyah, PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001;7(2):342–347.Google Scholar
30.Wagenlehner, FM, Naber, KG. Hospital-acquired urinary tract infections. J Hosp Infect 2000;46(3):171–181.Google Scholar
31.Healthcare Cost and Utilization Project (HCUPnet). Agency for Healthcare Research and Quality Web site, http://hcupnet.ahrq.gov/. Accessed August 4, 2009.Google Scholar
32.Zhan, D, Elixhauser, A, Richards, CL, et al.Identification of hospital-acquired catheter-associated urinary tract infections from Medicare claims: sensitivity and positive predictive value. Medical Care 2009;47(3:364–369.Google Scholar