HPMP INSIGHT April 2007
IN THIS ISSUE- DRG 320 - Kidney and Urinary Tract Infections, Age >17 with C
- Laboratory and Diagnostic Test
- Documentation
- Coding Hints
- Notification of Hospital Discharge Appeal Rights - Update on CMS-4105-F
DRG 320 - Kidney and Urinary Tract Infections, Age >17 with CC
Urinary Tract Infection (UTI) is a microbial infection in the urinary tract. The urinary tract includes organs that collect, store and release urine from the body. The kidneys collect waste and extra water from the blood to make urine. The ureters carry the urine from the kidneys to the bladder. The bladder stores the urine and squeezes it out when full and the urethra carries the urine out of the bladder.
The presence of greater than 100,000 microorganisms/ml in a urine culture of 1000 colonies/ml in a culture by catheter confirms an infection. Escherichia coli (E coli) is the most causative organism.
An infection of the urinary tract is defined as the abnormal presence of microorganisms in the urine. The most common signs and symptoms are burning pain on urination; cloudy, dark, turbid, or foul-smelling urine; fever or chills; frequent or intense urges to urinate; suprapubic, abdominal and/or flank pain; and/or fever.
Return to topLaboratory and Diagnostic Test
Blood work may reveal neutrophilic leukocytosis and positive blood culture, especially if infection involves upper urinary tract.
Cystoscopy and ureteral catheterization to obtain differential urine specimens localize the infection site.
Radiology such as intravenous urography or pyelography may demonstrate complicating factors such as calculi, abscess formation, and/or hydronephrosis.
Urinalysis may show significant bacteriuria. Positive urine culture reveals a growth of more than 100,000 colonies of single organism. The most common causative bacteria identified include Escherichia coli, Klebsiella, Proteus, Pseudomonas and Enterobacter.
Return to topDocumentation
In cases where the documentation indicates "urosepsis" the physician should be asked if the diagnosis of urosepsis is intended to mean (1) generalized sepsis (septicemia) caused by leakage of urine or toxic urine by-products into the general vascular circulation, or (2) urine contaminated by bacteria, bacterial by-products, or other toxic material but without other findings.
When UTI is documented as a complication of care (e.g. urinary catheter, vascular access device, etc.) code first the appropriate complication code (category 996) followed by the codes for the UTI and any known causative organism.
When there is documentation that the patient has an indwelling catheter, other device or evidence of a post-operative infection, review the medical record for documentation of a cause and effect relationship between the complication and the infection.
Return to topCoding Hints
- Code 599.0 is assigned when the physician is not able to identify the site(s) of the urinary tract infection.
- When the causative organism has been identified, it is reported as an additional code to the UTI (599.0).
- UTI due to Candidal yeast requires one code, 112.2 (Candidiasis of other urogenital sites).
- Assign only code 595.0, acute cystitis, when the physician states that the bladder is the specific site of the acute infection.
- Urinary tract infections that are due to sexually transmitted disease such as candidiasis or chlamydia would be coded elsewhere.
- Urinary tract infection due to E. coli is coded as 599.0 and 041.4.
- When the postoperative urinary tract infection is specified as a postoperative complication, code 997.5 is assigned. ICD-9-CM instructs coders to assign additional code of 599.0.
- Urinary tract infection may be a CC (complication and comorbidity) when reported as a secondary diagnosis.
Notification of Hospital Discharge Appeal Rights - Update on CMS-4105-F
CMS has posted a webpage on cms.hhs.gov where information and updates on the revised notification process will be posted including notices and instructions as they are finalized.
HPMP Compliance Workbook: http://providers.ipro.org/index/hpmp-compliance-workbook
DRG Coding Corner: http://www.ipro.org/drg
JENY: http://jeny.ipro.org/forumdisplay.php?f=34
Top 10 denied DRGs: http://providers.ipro.org/index/hpmp-topten-denied-drgs07
Top 7 DRGs: http://providers.ipro.org/index/hpmp-top-seven-drgs
Hospital Payment Monitoring Program: http://www.ipro.org/hpmp
Coding for Quality: Documentation and Coding Tips for Gastrointestinal Disorders: http://providers.ipro.org/index/coding-gi
Please pass this E-mail on to anyone who might be interested in the information. If you have not subscribed to HPMP Insight, visit http://lists.ipro.us/read/all_forums/subscribe?name=hpmp-announce to subscribe to this newsletter.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-NY-TSK3B-07-04
To access previous HPMP Insight updates, visit http://lists.ipro.us/read/?forum=hpmp-announce
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