Failure to Correctly Code Catheter-Associated Infections May Affect Medicare Payment Policy

Errors by hospital coders affect accurate nonpayment by the Centers for Medicare and Medicaid Services for catheter-associated hospital acquired infections, according to a study by researchers at the University of Michigan.

The study is published in the June issue of Infection Control & Hospital Epidemiology.

Researchers reviewed the medical records of 80 randomly selected adult patient discharges from May 2006-Sept. 2007 from the University of Michigan Health System with secondary diagnosis of a urinary tract infection. A physician-abstractor reviewed each case to classify the UTIs as catheter associated and/or hospital acquired, according to the study. Use of catheter-associated code 996.64 by UMHS coders was compared with state and national averages.

In 80 cases, coders identified 20 secondary-diagnosed UTIs as hospital-acquired, compared with the 37 identified by the physician-abstractors. Similarly, code 996.64 was never used by UMHS coders, but was deemed appropriate in 36 cases by the physician-abstractor, who determined 28 were hospital acquired and eight present on patient admission.

Reasons for the discrepancy could be due to the fact that catheter use was only documented on nurses' notes, which are not used by coders to assign discharge codes. Use of code 996.64 at UMHS was similar to state and national annual averages (around 1 percent), according to the study.

Researchers concluded by saying the use of catheter-associated codes and documentation of catheter-associated infections are "fraught with error," which may affect CMS's policy of not paying for hospital-acquired catheter-associated infections.

Read the study on hospital-acquired catheter-associated infections.