RAC/uti question

laura.jansenlaura.jansen
in CDI Talk Archive
We received a denial from our RAC that states we need to exclude a code for UTI 599.0 & downgrade the DRG

This patient was admitted with a fractured humerus that required surgical repair. She has a hx of chronic/recurrent uti's & was being treated for a uti prior to admission with Bactrim. She continued on the Bactrim during her stay & a ua was done pre-op & repeated again throughout the stay. No culture was done. While she did not have any urinary complaints while she was here, in the discharge summary the physician documented recurrent uti, to report to PCP if burning or pain resumes, & that she should complete her course of abx in 1 day. I believe this is a reportable secondary diagnosis. The problem I believe is that this is the only CC & also that this diagnosis was only included in the discharge summary. Any thoughts on the matter or does anyone have any coding clinics that could support our case? I plan to write an appeal since most appeals, when done, are in the hospitals favor.
Laura


Laura Jansen, RN, Clinical Documentation Improvement Specialist
St. Joseph's Hospital Breese, Southern Illinois Division
618-526-5638/618-526-5623

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    This is probably pertinent - See Coding Clinic, 2Q, 1996, pg7. Did the RAC cite this issue of Coding Clinic as a reason for the denial? If so, perhaps explain the patient is not on long-term prophylactic antibiotics to 'prevent' recurrence of an active (acute) infection, rather the patient is completing antibiotic therapy for a current, acute and episodic condition.

    Question:

    A patient is admitted to the hospital with atrial fibrillation. The patient is on prophylactic Septra for chronic recurrent UTIs and is continued on this medication during the current hospitalization. The patient had no urinary symptoms or problems during this short stay. Is the fact that the patient was given Septra during her admission enough to substantiate using code 599.0, Urinary tract infection, site not specified, or should a V code be used for history of UTIs?

    Answer:
    Assign code 427.31, Atrial fibrillation, as the principal diagnosis. Assign code V58.69, Long-term (current) use of other medications, and code V13.09, Personal history of disorders of urinary system, Other, as additional diagnoses. Code V58.69 would be assigned to identify the fact that the patient is on long-term use of Septra. Since the patient did not have any signs or symptoms of a UTI during this admission, it would be inappropriate to assign a code for the condition. A UTI is a condition that occurs as an acute, episodic condition, which may or may not recur if the prophylactic antibiotic is discontinued.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • fantinsfantins
    edited May 2016
    Was it documented and coded as POA? It makes a difference.


    Susan
  • ddouthitddouthit
    edited May 2016
    Laura,

    Did they cite a coding clinic in their denial? The below coding clinic comes to mind but unfortunately not going to help your appeal I'm afraid. My only thought is that it doesn't appear the patient is receiving a maintenance antibiotics but ongoing treatment for an acute UTI, since antibiotics will be completed one day post discharge. You might check your anesthesia physician preop assessment and see if it is documented there.
    Good luck!

    Chronic recurrent urinary tract infection w/o urinary symptoms
    Coding Clinic, Second Quarter 1996 Page: 7 Effective with discharges: May 1, 1996


    Question:

    A patient is admitted to the hospital with atrial fibrillation. The patient is on prophylactic Septra for chronic recurrent UTIs and is continued on this medication during the current hospitalization. The patient had no urinary symptoms or problems during this short stay. Is the fact that the patient was given Septra during her admission enough to substantiate using code 599.0, Urinary tract infection, site not specified, or should V code be used for history of UTIs?

    Answer:

    Note from 3M:
    As of October 1, 1998, long term (current) use of antibiotics is coded to V58.62.

    Assign code 427.31, Atrial fibrillation, as the principal diagnosis. Assign code V58.69, Long-term (current) use of other medications, and code V13.09, Personal history of disorders of urinary system, Other, as additional diagnoses. Code V58.69 would be assigned to identify the fact that the patient is on long-term use of Septra. Since the patient did not have any signs or symptoms of a UTI during this admission, it would be inappropriate to assign a code for the condition. A UTI is a condition that occurs as an acute, episodic condition, which may or may not recur if the prophylactic antibiotic is discontinued.


    Dorie Douthit, RHIT,CCS
    CDI Program/HIM
    ddouthit@stmarysathens.org
    706-389-3364
    St. Mary's Health Care System
    1230 Baxter Street
    Athens, Georgia 30606
  • carmella.gaycarmella.gay
    edited May 2016
    I agree, the patient was receiving medication but also had diagnostic studies done - that constitutes reporting the code.

    Carmella
  • laura.jansenlaura.jansen
    edited May 2016
    RAC did not cite a coding clinic just the definition for reporting a secondary diagnosis. And yes the anesthesia record does list UTI in their assessment. I felt it was reportable because we continued treatment for an acute problem & that it was not prophylactic as in the coding clinic below.
    Thanks
    Laura
  • ddouthitddouthit
    edited May 2016
    I agree...does not sound prophylactic. Good luck! You definitely have an argument for meeting criteria for secondary diagnosis.

    Dorie Douthit, RHIT,CCS
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