HAC vs CLABSI

vanessa.falkoff

Hi all,

I am confused about CLABSI and HACs. When I first came to this position
six months ago, everyone was very concerned about cases that did not
meet the CDC criteria for CLABSI being coded to 999.31 which results in
a "HAC."

The coding staff explained it to me this way..."The code 999.31 results
in a "HAC. While 999.31 includes CLABSIs, the code is not intended to
capture only CLABSIs. The 999.31 category includes any infections due
to central venous catheters, i.e. , cellulitis, abscess, etc. Within the
limitations of the current coding system, 999.31 will sometimes be
assigned for other types of infections besides CLABSI's. Coding Clinic
fourth quarter 2007 pg 96 &97 says " possible complications associated
with these catheters include local and systemic infectious complications
including local site infections, catheter related bloodstream
infections, septic thrombophlebitis, endocarditis, and other metastatic
infections." Physician documentation is the key, as coders are legally
required to code what physician's document."

Now I am seeing a discussion on another forum about this issue, and
wondering if the above explanation is accurate.

If it isn't a CLABSI, can it still be a HAC?

Thanks in advance for your help!

Vanessa Falkoff, RN
Clinical Documentation Coordinator
University Medical Center
(702) 383-7322
vanessa.falkoff@umcsn.com

lspryszak

The coders' advice is correct. Quality reporting allows conditions to be reported from clinical interpretation, unlike coding. There is a difference.

Example:

For quality measures when the chart is abstracted, something may be reported as present on admission just because the culture was done in the ED. BUT...if the diagnosis is not mentioned by the attending in the H/P, ED notes or as clearly POA in the progress notes, then the coder has to assign a POA indicator of "No" -- now it's a HAC.

POA indicators can only be assigned based on the Provider's documentation. To do otherwise would be assumptive coding - a no, no.

As the CDI manager I was involved in chart abstraction for POA assignment for many, many months to validate correct POA assignment by the coders. The group involved in these chart reviews included the infection control nurse, the wound nurse and the VP of Quality and Patient Safety (a MD). The clinicians would insist that the POA indicator be changed from "N" to "Y" based on the clinical picture.

The HIM director had to tell the clinicians (over and over) that unless the provider had clearly DOCUMENTED something as POA -- it would be coded as a "N". It didn't matter if it was in the nursing admission assessment, the wound care assessment, whatever; because that documentation was not from a "provider" - that person legally accountable for establishing the diagnosis (the definition of a provider for POA purposes can be found in the Official Guidelines for Coding and Reporting):

"As stated in the Introduction to the ICD-9-CM Official Guidelines for Coding and Reporting, a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Medical record documentation from any provider involved in the care and treatment of the patient may be used to support the determination of whether a condition was present on admission or not. In the context of the official coding guidelines, the term “provider” means a physician or any qualified healthcare practitioner who is legally accountable for establishing the patient’s diagnosis.

So - bottom line: if the diagnosis is not clearly stated by the PROVIDER as POA, then it just isn't and will assigned a POA indicator of "N".

This guideline really frustrates the people involved in quality measure reporting, BUT the coding rules are the final, ultimate authority in these situations.

Unknown

Sounds like an excellent query opportunity for Documentation Specialists and coders alike.


Charlene Thiry RN, BSN, CPC, CCDS
Menorah Medical Center