Self Cath

tracyaboldt@gmail.com

Good morning/afternoon ACDIS community- 

What is best practice regarding a patient who is self cathing (either self or in NH by staff) several times a day and presents to hospital with UTI?  I my previous life the indwelling catheter r/t UTI can not be used in a case where a patient is self cathing multiple times per day?  I am interested in your thoughts. Are you using the UTI d/t indwelling catheter or coding simple UTI w/out the link to the catheter via self cathing. 

Thanks so much for your time and I look forward to the discussion.

Tracy Boldt

morris-jeff@CooperHealth.edu

Hi Tracy,

What about T83518A (unless it's not the initial encounter) for this one? The code title is "infection and inflammatory reaction due to other urinary catheter"

I may be way off base but just took a quick look. I don't think I would use the code for UTI due to indwelling.

Interesting topic!

Jeff

tracyaboldt@gmail.com

Thanks Jeff that code may not work as it seems it is for the "ostomy".  The cases I am referring to are patient that actually self cath (traditional) and do not have an indwelling.  I appreciate your help.....any additional thoughts?   

T

lprescott1

I think I would go with T83.598A- infection and inflammatory reaction due to other prosthetic device, implant or graft in urinary system? Then a second code to identify the infection.

tracyaboldt@gmail.com

Thank you, all.  Now which code is most appropriate?  I did some additional homework around T83518A and I do think we may be able to use this to capture those patients who "self cath" present with UTI.  I hope more additional members provide feedback.  

cseluke

We used to use 99.75 in ICD 9 for a UTI related to self-catheterization. 

I just found this in the coding handbook embedded in 3M.

Revisions and the addition of new codes at subcategory T83.0, Mechanical complication of urinary catheter, were made to capture the correct diagnosis coding of all urinary catheters, not limited to the term "indwelling." Terminology used in the practice of urology specifically alludes to the urethral catheter as indwelling. All other catheters are related to specific organs in which they reside while in the body.

Maybe T83.518- Infection due to other urinary catheter is the best choice?

afrady@blr.com

Time for one of you to write coding clinic and then come back and share what you heard. 

afloyd24

We have already contacted coding clinic on this subject!  I attached their response letter.  

lprescott1

Thank you.

cseluke

afloyd24 said:

We have already contacted coding clinic on this subject!  I attached their response letter.  

Thank you for posting. Did Coding Clinic ever publish this advice or was it just in the letter they sent you?

Cathy

afloyd24

They did not publish the response, only sent the attached letter. 

laura.rogers@franciscanalliance.org

Thanks so much for sharing it with us.  There is now a Coding/CDI meeting our organization can cancel! 

Laura

tracyaboldt@gmail.com

All-

Great feedback, I think there was an update Nov 2106 with the following information below (we are using the T83 code).  I have submitted a question to CC to confirm or deny the use of T83 in cases where the patient presents with a UTI d/t self cathing. 

VOLUME 3 FOURTH QUARTER

NUMBER 4 2016, Page 70

Complications of Genitourinary Prosthetic Devices, Implants, and Grafts

Category T83, Complications of genitourinary prosthetic devices, implants, and grafts has been revised at the request of the American Urological Association (AUA). These changes are intended to capture current terminology as well as to better represent complications of certain urinary catheters and other devices that are not currently represented in ICD-10-CM.

Revisions and the addition of new codes at subcategory T83.0, Mechanical complication of urinary catheter, were made to capture the correct diagnosis coding of all urinary catheters, not limited to the term “indwelling.” Terminology used in the practice of urology specifically alludes to the urethral catheter as indwelling. All other catheters are related to specific organs in which they reside while in the body.

Subcategory T83.1, Mechanical complication of other urinary devices and implants, was revised and new codes added to account for breakdown, displacement and other mechanical complications of all existing urinary devices and implants that are available.

Two new codes were created at subcategory T83.2, Mechanical complication of graft of urinary organ, to identify erosion (T83.24) and exposure (T83.25) of grafts used in the urinary system. Urinary grafts, such as a pubovaginal sling using rectus fascia or fascia lata, can erode to surrounding tissues or expose into an organ. This can cause pain, inflammation and infection.

Changes were made and new codes created at subcategory T83.4, Mechanical complication of devices, prosthetics, implants and grafts of genital tract, to allow coding complications of a testicular prosthesis implant.

Subcategories T83.5, Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system; and T83.6, Infection and inflammatory reaction due to prosthetic device, implant and graft in genital tract, were revised and new codes created to maintain consistency with other subcategories of T83 and to better capture infection and inflammation due to prosthetic devices, implants, and grafts, both in the urinary system and the genital tract.

The creation of new codes and revisions at subcategory T83.7, Complications due to implanted mesh and other prosthetic materials, to surrounding organ or tissue, were made to capture erosion (T83.71-) and exposure (T83.72-) specific to the use of urethral mesh and urethral/ureteral bulking agents. In addition, code T83.711 has been revised and now is specific only for vaginal mesh. All other types of mesh and prosthetic materials have been reclassified to codes T83.718/T83.728 and T83.719/T83.729, respectively.

Coding advice or code assignments contained in this issue effective with discharges October 1, 2016.

Thanks,

Tracy Boldt

 

 

afrady@blr.com

Here is more debate:

I think this is a good example of why it is BEST to just PICK UP AN ACTUAL code book some times: (Which i should have but didn't do when i looked at this discussion previously).

For further clarification, here are the actual codes now in the T83 category.

Infection and inflammatory reaction due to:
T83.510 :Cystostomy catheter"
T83.511: Indwelling urethral catheter"
T83.512 "nephrostomy catheter"
T83.518: "other urinary catheter"
T83.590: "implanted urinary neurostimulation device"
T83.591: "implanted urinary sphincter"
T83.592: ""indwelling ureteral stent"
T83.593: "other urinary stent"
T83.598: ""other prosthetic device, implant and graft"
T83.6: "prosthetic device, implant and graft in genital tract"

To my eyes, the letter from the AHA looks absolutely.....WRONG.   (The suggested T83.59x)

T83.518 appears to be the correct choice. 

My rationale:   Yes under T83.518 there appears to be examples of artifical openings listed in the includes notes, but remember, things that are in the includes notes ARE ADDITIONAL scenarios covered under the code..they are NOT MEANT TO DEFINE the code.  In fact, one can hardly call those artificial opening scenarios "catheter" as they are more accurately defined as drains put in via artificial access.  The description of the code under T83.518 says "other urinary CATHETER" which seems to be appropriate.  I don't see how a code with a description of "other catheter" would be only for artificial openings?

Coding clinic: "A basic rule of coding is that if the indexed term appears incorrect, further research is required"....so i am going by the indexed terminology.  

The reason I am not happy with T83.59:"other prosthetic device, implant and graft"  is that one can hardly call an in and out cath an "implanted" device....and everything  under T83.59x is...IMPLANTED (or seems to be a permanent device, implant or graft), that does not seem appropriate for an in and out situation. 

alkanne

https://forums.acdis.org/discussion/comment/18871#Comment_18871

i am having trouble finding the attached response letter regarding the self-cath. could you possible attach it again?

afloyd24

Clarification of coding UTI due to in and out self catheterization March 2016.pdf

Attached. I think there may have been new guidance published in coding clinic since this response? You may want to research.