533. Coding for Reimbursement: The Under-Estimated Cost of Catheter-Associated Urinary Tract Infections (CA-UTI)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: CMS-Medicare anticipates that their rule changes for nonpayment of hospital acquired conditions will be a powerful incentive to prevent CA-UTI. We have examined the frequency of coded CA-UTI (ICD-9 996.64) in Medicare patient encounters at two hospitals from 2000 through 2008 and performed a matched case control study to estimate the excess costs of CA-UTI.
Methods: We studied 56,554 patients with an indwelling urinary catheter during the 9 year period Jan 1, 2000 to Dec 31, 2008 at two tertiary facilities in Salt Lake City, Utah. We defined a case as a Medicare patient with the ICD-9 code 996.64, “Infection and inflammatory reaction due to indwelling urinary catheter”, who did not have a UTI present on admission. Matched controls were selected from Medicare patients with no UTI on admit, and no diagnosed CA-UTI during follow-up (n=23,748). Matching criteria were gender, facility, any surgery, admit year, severity of illness, and Diagnosis Related Group (DRG). Demographic, clinical, and cost data were compared using Pearson’s chi square for categorical variables and an independent sample’s t-test for continuous variables.
Results: Among the Medicare population of 28,888 patients we found only 355 cases coded for ICD-9 code 996.64, representing 1.2% of all Medicare encounters and 0.6% of all episodes of catheterization. However, 1604 patients or 5.6% of all encounters developed CA-UTI during hospitalization. After matching, 277 cases were matched to controls. In this analysis, length of stay was longer in the cases versus controls (9.7 days vs. 7.5 days, p<0.001). Mean duration of catheter use was also longer among cases (10.4 days vs. 6.4, p<0.001). Median total costs per encounter were significantly higher in cases than controls ($16,913 vs.$15,553; p<0.05).
Conclusion: Cost calculations based on the number of patients coded for CA-UTI underestimate the true costs of CA-UTI. Effective prevention of CA-UTI could produce cost savings that far exceed the lost reimbursement.
John Burke, MD, LDS Hospital, Salt Lake CIty, UT, Kristin Dascomb, MD, PhD, Intermountain Medical Center, Salt Lake City, UT, Rajesh Mehta, RPh, MS, Intermountain Health Care, Salt Lake City, UT, David Pombo, MD, LDS Hospital, Salt Lake City, UT and  K. K. Dascomb, None..
R. Mehta, None..
D. Pombo, None..
J. P. Burke, None.