Review: Errors rampant in hospital-acquired CA-UTI coding

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Hospital coders rarely use the catheter association code needed to identify catheter-associated urinary tract infections (CA-UTIs) among secondary-diagnosis UTIs and may reduce financial impact of Medicare’s payment policy, according to an article in the June issue of Infection Control and Hospital Epidemiology.

Jennifer Meddings, MD, MSc, from the department of internal medicine at the University of Michigan in Ann Arbor, and colleagues 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 UTIs.

The review set to evaluate whether hospital-acquired CA-UTIs are accurately documented in discharge records with the use of ICD-9 codes so that nonpayment is triggered, as mandated by the Centers for Medicare & Medicaid Services (CMS) Hospital-Acquired Conditions Initiative.

The mean patient age was 58 years where 70 percent were women and the median length of hospital stay was six days. According to the researchers, 62 percent used urinary catheters during hospitalization while hospital coders had listed 20 secondary-diagnosis UTIs (25 percent) as hospital acquired, whereas physician abstractors indicated that 37 (46 percent) were hospital acquired.

Hospital coders had identified no CA-UTIs whereas physician abstractors identified 36 CA-UTIs (45 percent; 28 hospital-acquired and eight 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, Meddings and colleagues stated.

“Coders often listed a UTI as present on admission, although the medical record indicated that it was hospital acquired,” concluded the researchers. “Because coding of hospital-acquired CA-UTI seems to be fraught with error, nonpayment according to CMS policy may not reliably occur.”