RSS Feeds
Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes
- Sanjay Saint, MD, MPH;
- Jennifer A. Meddings, MD, MSc;
- David Calfee, MD, MS;
- Christine P. Kowalski, MPH; and
- Sarah L. Krein, PhD, RN
- From the Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, and the Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan, and Mount Sinai School of Medicine, New York, New York.
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Figure. Coding for a hospital-acquired catheter-associated urinary tract infection, resulting in outcomes of no extra payment (if coded correctly) or potential extra payment by default (if coded incorrectly).*E. coli = Escherichia coli. * The catheter-associated urinary tract infection diagnosis will increase payment if the patient has no other complications or comorbid conditions that would have generated the same level of illness as measured by the Medicare Severity Diagnosis-Related Group assignment used to determine payment rates. † “Error” refers to an omission (incompleteness) or mistake in the codes assigned for billing, which can lead to an inaccurate misclassification of a hospital-acquired catheter-associated urinary tract infection to a condition that would generate payment (such as a non–catheter-associated urinary tract infection, or a catheter-associated urinary tract infection that was present on admission). Such errors could occur because the provider documentation did not accurately describe the conditions sufficient for the hospital coder to recognize, or because the hospital coder did not understand that all 3 codes were required for this specific condition.
