Re: Coding UTI within last 30 days, Rena and Nathan?

[Nathan Lake]

You are not alone in being unsure of how to do this. To initiate the coding of I2j a CMS Q&A states the following:   QUESTION 2 - 21: The RAI User�s Manual indicates that lab results are required in order to code a urinary tract infection (UTI) to be coded at Item I2j. Recent medical literature indicates that colonized MRSA can be present even in the absence of symptoms. A physician might order antibiotics, without ordering labs, when a resident with colonized MRSA experiences symptoms of a UTI. Are lab results required in order to code a UTI at Item I2j? Once a urine culture has been done, a physician�s working diagnosis of UTI can be coded at Item I2j. The diagnosis of UTI, along with lab results when available, must be documented in the resident�s clinical record. In response to your question regarding the resident with colonized MRSA, we consulted with the Centers for Disease Control (CDC) who provided the following information: "A physician often prescribes empiric antimicrobial therapy for a suspected infection after a culture is obtained, but prior to receiving the culture results. The confirmed diagnosis of UTI will depend on the culture results and other clinical assessment to determine appropriateness and continuation of antimicrobial therapy. This should not be any different even if the patient is known to be colonized with an antibiotic resistant organism. An appropriate culture will help to ensure the diagnosis of infection is correct, and the appropriate antimicrobial is prescribed to treat the infection. The CDC does not recommend routine antimicrobial treatment for the purposes of attempting to eradicate colonization of MRSA or any other antimicrobial resistant organism." Once treatment has commenced, I would say that you can continue coding I2j until treatment is finished. Be careful however if you still have MDs that continue antibiotics almost as a prophylaxis. I think it is just as important to be consistent in how you code this. Don't code one time from the end of treatment and another time from the disappearance of symptoms. Nathan     ----- Original Message ----- From: Olga Lawrence To: [EMAIL PROTECTED] Sent: Wednesday, March 17, 2004 1:30 PM Subject: Coding UTI within last 30 days, Rena and Nathan? What criteria needs to be satisfied for the coding of "UTI within last 30 days, etc..."? Do significant lab finding within the last 30 days and symptomology and working diagnosis (UTI) need to be present at the same time? What if the resident is being treated with the antibiotic and is not presenting with dysuria, hematuria, etc...? Do we count from the date the last dose of antibiotic was administered; or , do we count 30 days from the firs tday of antibiotic treatment? Our QIs show high occurrence of UTIs, and I feel it may hinge on how staff interpret when to code for UTI. Rena and Nathan's input would be great...the RAI manual does not seem to be clear on this issue (at least to me). Thank you!                                   Do you Yahoo!? Yahoo! Mail - More reliable, more storage, less spam