Hospital-acquired conditions: Are your coders catching Medicare no-payment codes?

Hospitals may be receiving Medicare payments they don't deserve under the hospital-acquired condition payment policies established by the Centers for Medicare and Medicaid Services, according to a new study published in the June issue of Infection Control and Hospital Epidemiology.

Researchers conducted a random, retrospective medical record review of 80 adult discharges with secondary-diagnosis urinary tract infections (UTIs) from the University of Michigan Health System (UMHS) in Ann Arbor from May 2006 to September 2007. UMHS coding staff had cited 20 secondary-diagnosis UTIs (25 percent) as hospital-acquired compared to 37 (46 percent) for the physician reviewers. Hospital coders did not identify any catheter-associated UTIs (CA-UTIs), while the physician reviewers found  36 CA-UTIs (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," note the researchers. "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."

To learn more:
- read the journal abstract
- review the hospital-acquired conditions that have Medicare payment implications