UTI Denials based on not enough clinical evidence

bbogda@morrishospital.orgbbogda@morrishospital.org
in Denials

I have gotten recent denials for patients that have urinalysis suspicious for UTI - positive protein, hi WBC, 2-3 + bacteria, large ULE, but the urine culture has come back negative, or considered negative.  The payer also cites lack of 'symptoms usually associated with UTI' such as dysuria, frequency, pelvic pain, etc.  These patients are often from a nursing home with dementia and are not good historians, and/or they just don't have symptoms.  The doctor suspects a urinary tract infection, documents UTI and the patient is treated for UTI, but the payer says there is not enough evidence.  I always thought that a positive culture was not necessary.  Should I be re-educating the doctors that we need a positive culture in order to call it a UTI?

Thank you,

Betty

Comments

  • lprescott1lprescott1
    It would be important to include if the patient had recently been treated with antibiotics. I would also encourage providers when the culture is negative to elaborate their reasoning as to the why a UTI is present- they should clinically validate its presence.
Sign In or Register to comment.