Criteria set by NQF, CDC, AHRQ

Does anyone take this criteria into consideration whey querying for CAUTI, CLABSI, etc?

With the implementation of the Value-Based Purchasing (VBP) Program, Hospital-Acquired Condition (HAC) Reduction Program, and the list of Hospital-Acquired Conditions (HAC), CDI efforts must focus on documentation implications beyond individual MS-DRG or APR-DRG optimization. Specific criteria established by the National Quality Forum (NQF), Agency for Healthcare Research and Quality (AHRQ), and United States Centers for Disease Control and Prevention (CDC) should be applied when requesting clarification.  **Forms with implications set forth in these initiatives (e.g., CAUTI, CLABSI) should be evaluated to avoid the unintended consequences of documentation (e.g., linking sepsis to a central line when the CDC criteria are not met). For example, if the organism from the blood culture and another source (e.g., urine, wound, etc.) match, it is not a CLABSI as defined by the CDC. 


  • edited January 2018

    Great question!

    We absolutely agree that these other considerations need to be factored in when making a determination about not only if a query should be placed but also when a condition is valid for even reporting via coding.   We should not be pushing towards the short term goals of adding CC's when they are 1) Questionable and 2) Do financial and profiling harm to the facility in terms of value reimbursement methodologies and public profiling.    In fact, I use the NQF as an example in the boot camp to discourage students from placing a query for a post-op Ileus for a patient with abdominal surgery until day 5.  Afterall, if the NQF considers a lack of a return of bowel function integral to the abdominal surgery until day 5, then why shouldn't we?   

    Sometimes you are just playing the odds.  70% to 80% of UTIs in the presence of a cath are in fact, due to the cath.  However, this highlights the importance of immediately getting a UA and culture at the point of contact in order to help demonstrate accurate POA assignment.  You will have a hard time convincing me that when we place a foley at 2:00 and a new onset UTI is determined at 3:00, that is a foley acquired condition...yet if you aren't paying attention, it COULD end up being coded as such.  As you have mentioned the CDC reporting guidelines avoid these pitfall some what as the criteria actually specify the time table of events which must occur prior to abstracting for infections dz reporting.  Caution is warranted however, what an infection control specialists can abstract is very different than what a coder can report, as the coding requires specific language form a treating physician while the CDC reporting only requires certain criteria to have been met regardless of the physician documentation. 

    Ask me if I believe a homeless patient admitted on Thursday did not already have a stage 1 or 2 decubitus ulcer discovered on Friday?  Spoiler alert, I don't.     You wouldn't take a patient who was sleeping on the side walk, put them in a therapeutic hospital bed for only one day and some are the cause of a pressure ulcer.   What happens in these cases is the pressure ulcer was already present but it was difficult to identify visually on inspection, and it just became observable on day 2..the hospital didn't cause it.    I think we some times forget to apply the "smell test" or the "common sense" test to our documentation and coding. 

    Care should be applied when trying to apply CDC or NQF guidelines to coding as coders cannot follow those guidelines.

    Be that as it may, I absolutely encourage you to work with these departments to come and educate both the coders and the CDI so that you can start to get on the same page with regards to when it makes sense for the facility to report a condition.

    Fragmentation and conflicting information from these groups will some times directly contradict each other with one department tying to add a diagnosis that another department seeks to remove.

    This sort of fragmentation just aggravates and infuriates both physicians and coders.   It is not productive to tell those two groups of people to simultaneously do something...and also not to do it.

    Ultimately  for CDI and coding the physician has the final say, not the criteria.

  • CLABSI and CAUTI are CDC-defined conditions based on objective clinical findings used by the Quality Dept. having nothing to do with provider documentation or coding.

    For coding purposes  a central line infection or UTI are considered "hospital acquired" based on provider documentation and POA status, not the CDC case definitions.

    The terms CLABSI and CAUTI should really only be used to identify infections meeting the CDC case definitions.

    Richard D. Pinson, MD, FACP, CCS
    Pinson & Tang
    CDI Educators and Advisers
    Authors of the CDI Pocket Guide

  • Mr. Frady,
    Could you please send a link to the NQFs criteria for Post operative ileus? I've searched to no avail.
    Thank you
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