UTI with Foley

jillian.bisbe

This may be a silly question. Does a query needs to be sent if the physician states “Complicated Urinary Tract Infection Associated with Indwelling Foley Catheter”?

Does it really have to say "due to"? I would think the above documentation is enough but I wanted to clarify as I've been told differently in the past. TY!

lauraschafferjones@gmail.com

That statement only says that the patient has a UTI and an Indwelling Foley Catheter. While most people would assume it mean that the UTI is due to the Foley, but coders are not allowed to assume. Coders need the physician to actually come out and say that the UTI is due to the Foley.  

lucy.walton@eamc.org

See OCG in Section I.A.15 (titled with) "the word with or in should be interpreted to mean associated with or due to when it appears in a code title, the Alphabetic index, or an instructional note in the tabular list. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic index or tabular list. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.

jillian.bisbe

Correct me if I'm wrong but I don't see anywhere in the Index or tabular list where that would apply in this scenario.

afrady@blr.com

jillian.bisbe said:

Correct me if I'm wrong but I don't see anywhere in the Index or tabular list where that would apply in this scenario.

That is correct.  The word "with" does not present itself in the code title "T83.590 "Infection and inflammatory reaction due to indwelling urethral catheter".    The with rule does not apply to the phrase "due to"   In the look up in a  code book it is Infection ->Due to ore resulting from -> device implant or graft -> Urinary -> Urethral indwelling.    With is not part of the equation.  

As silly as it sounds, the doctor must say something like "due to", "as a result of", "induced by" etc. to state the cause and effect and most coders would prefer "due to".