"Similarly, our exploratory analyses of Michigan, California, and nationwide discharge data also indicate that the catheter association code is applied to only approximately 1% of all secondary diagnosis UTIs submitted for payment."
Nancy Foster, vice president for quality and patient safety policy for the American Hospital Association, said she agrees that accurate coding is a complex process. But she says that even if hospitals fail to correctly code, it would not have much impact on payment.
That's because the bulk of catheter-associated urinary tract infections would not result in reduced payment to hospitals because the patients that got these infections already have so many complications that they are already in highest payment categories. "It isn't having a very significant impact on payment," she says.
Interviewed by phone, Meddings agreed that it may not have much of an impact because the sample of patients was very very sick, for example, many of them were on the list or had already had an organ transplant.
But she said that urinary tract infections are common, as is the use of catheters in hospitals. And often, the use of a catheter is not reflected in the medical record.
"Catheters are considered part of the general supply, like bandages. When they're used they're not scanned for a bar code, and there's no tracking system to link patients with urinary tract infections to catheters," she said.
When auditors and hospital coders look through discharge records to decide on what codes to use for billing, often the catheter link is not found, she said.
Meddings and others wrote in the article that they did not think CMS had explored or anticipated this phenomenon during the development of the policy.