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99% of CA UTIs Incorrectly Coded, Study Says

Cheryl Clark, for HealthLeaders Media, August 17, 2010

New federal penalties for catheter-associated urinary tract infections that limit reimbursement to hospitals where they occur may be ineffective because hospital staffs often don't accurately code those cases.

That's the finding in a recent study by University of Michigan Health System's Jennifer Meddings, MD, and others who wrote that hospital staff accurately used the correct ICD-9 code for CA-UTI, 996.64, only 1% of the time in a sample of patients hospitalized in 2007.

Accurately recording such hospital-acquired infections requires a complicated three-step process that is seldom completed, the authors said. That would result in the hospitals receiving full federal payment, which defeats the purpose of the federal penalty to improve care, they wrote in a recent edition of the journal Infection Control and Hospital Epidemiology.

"If no improvements are made in applying diagnosis codes to accurately identify hospital-acquired CA-UTIs, the nonpayment policy will have little if any effect on hospital reimbursement for this complication, because hospitals will continue to be eligible for additional payment for UTIs," Meddings and colleagues wrote.

"Furthermore, hospitals that face little financial incentive (or penalty) may be unlikely to invest in the processes necessary to improve care."

Additionally, the researchers discovered that "hospital coders often code UTIs as present on admission when the medical record indicated that the UTIs were hospital- acquired."

The researchers looked at medical records at the University of Michigan Health System in 2007, a period that ended nine months before the Centers for Medicare and Medicaid Services' (CMS) Hospital Acquired Conditions Initiative's list of eight such conditions not eligible for payment, as of Oct. 1, 2008.

The researchers sampled medical records and found 80 patients who had evidence of a catheter-linked urinary tract infection during their hospitalization. Of those, 37, or 46%, were hospital-acquired, according to their review, although none were identified as "hospital-acquired" or "nosocomial."

"Yet no cases in our sample, and only 1.2% of cases of secondary-diagnosis UTI at UMHS during 2007, were identified as Catheter-Associated Urinary Tract Infections by hospital coders in the administrative discharge data set.

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