What is the Likely Financial Impact of Not Paying for Hospital-Acquired Catheter-Associated Urinary Tract Infection? A Statewide Analysis

What is the Likely Financial Impact of Not Paying for Hospital-Acquired Catheter-Associated Urinary Tract Infection?  A Statewide Analysis

Background: Since October 2008, the Centers for Medicare and Medicaid Services no longer pay hospitals for specific complications, including the most common nosocomial infection: catheter-associated urinary tract infection (CAUTI).  Yet, the policy's rules are complex to detect and deny payment for hospital-acquired CAUTI.  Hospitals will continue to receive extra payment if CAUTI is not correctly identified by diagnosis codes, or if patients have other co-morbidities not on the "no-pay" list. 

Objective: To evaluate hospital billing abstracts for CAUTI and non-catheter-associated urinary tract infection (UTI) cases, to describe how hospitals used the catheter code 996.64 necessary to identify UTIs as CAUTIs, and to describe the patient population discharged with CAUTI or UTI as secondary diagnoses (i.e., not a principal diagnosis).

Methods: We evaluated the administrative dataset for all adult discharges from acute care hospitals in the State of Michigan using the 2007 Healthcare Cost and Utilization Project (HCUP) State Inpatient Dataset.  Secondary diagnosis CAUTIs were identified by the catheter code 996.64 without a UTI ICD-9-CM code as principal diagnosis.  Secondary diagnosis UTIs had a UTI code without the catheter code.  We assessed rates of co-morbid diabetes, renal failure, paralysis, other neurologic disease, congestive heart failure, and decubitus ulcers.   

Results: Characteristics of patients discharged with secondary diagnoses of UTI and CAUTI are summarized in the Table.  Although UTI was a common secondary diagnosis (9.4%), very few CAUTIs were identified (0.09%).  Co-morbid conditions were common in patients with secondary diagnoses of UTI, with even higher rates in patients with secondary diagnosis CAUTIs – particularly for paraplegia and decubitus ulcers.

All 144 hospitals requested payment for secondary-diagnosis UTIs (not CAUTI), ranging from 2 to 38% of discharges.  Hospital rates of secondary diagnosis CAUTIs ranged from 0 to 2.3% of discharges.  Forty-four  (31%) hospitals did not list the catheter code for any discharges despite 9.6% of discharges having a secondary diagnosis of UTI; 94 (65%) hospitals requested payment for <5 cases of CAUTI as secondary diagnoses. 

Conclusions: Rare use of the catheter code 996.64 in contrast to high rates of secondary diagnosis UTIs suggests many CAUTI cases may be misidentified as non-catheter-associated UTIs in hospital billing abstracts.  Patients discharged with secondary diagnoses of UTIs and CAUTIs often have other co-morbidities.  The financial impact of non-payment for hospital-acquired CAUTI will likely be low due to rare use of the catheter code and other patient co-morbidities that could generate extra payment even without a secondary diagnosis of CAUTI.