Hospital-Acquired Catheter-Associated Urinary Tract Infection: Documentation and Coding Issues May Reduce Financial Impact of Medicare's New Payment Policy
Hospital-Acquired Catheter-Associated Urinary Tract Infection: Documentation and Coding Issues May Reduce Financial Impact of Medicare's New Payment Policy
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DOI：
10.1086/652523
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发表时间：
2010-06-01
影响因子：
4.5
通讯作者：
McMahon, Laurence F., Jr.
中科院分区：
文献类型：
--
作者：
Meddings, Jennifer;Saint, Sanjay;McMahon, Laurence F., Jr.
OBJECTIVE.评估出院记录中是否准确记录了医院获得性导管相关尿路感染（CA-UTIs），并使用国际疾病分类第九版临床修改诊断代码，以便根据医疗保险和医疗补助服务中心（CMS）医院获得性疾病倡议的要求触发不付款。我们对2006年5月至2007年9月从密歇根大学卫生系统（UMHS）随机选择的80例二级诊断尿路感染（UTIs）的成人出院病例进行了回顾性病历审查。一名医生-摘要员审查了每条记录，将UTI分类为导管相关和/或医院获得性;将这些结果（视为“金标准”）与医院编码员分配的诊断代码进行比较。通过使用医疗保健成本和利用项目数据，将UMHS编码器每年使用的导管相关代码（996.64）与州和美国的比率进行比较。患者平均年龄为58岁; 56例（70%）为女性;中位住院时间为6天; 50例患者（62%）在住院期间使用导尿管。医院编码员将20例（25%）二级诊断UTI列为医院获得性，而医生摘要员指出37例（46%）为医院获得性。医院编码员未识别出CA-UTI（从未使用编码996.64），而医生提取者识别出36例CA-UTI（45%; 28例医院获得，8例入院时存在）。导管使用通常仅从护理记录中明显可见，与医生记录不同，编码器无法使用护理记录分配出院代码。州和美国996.64编码的年发生率（类似于1%的二级诊断UTI）与UMHS相似。医院编码人员很少使用导管关联代码来识别二级诊断UTI中的CA-UTI。编码器通常在入院时将UTI列为存在，尽管医疗记录表明它是医院获得的。由于医院获得性CA-UTI的编码似乎充满了错误，根据CMS政策不支付可能不会可靠地发生。感染控制医院流行病学2010; 31（6）：627-633
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 (similar to 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. Infect Control Hosp Epidemiol 2010; 31(6): 627-633