Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
The new MDS guidelines for coding UTI’s without a in indwelling catheter are causing significant confusion in the industry. The criterion is drastically different than the past definition and many nurses require time to assimilate the change. The refinement is a result of studies depicting the probability of urinary tract infections when symptoms are non-existent combined with the evidenced based value of a urine culture for microbiologic confirmation.
The below synopsis is intended to provide clarity on the subject matter:
The change in the coding for Section I (Active Diagnoses): I2300 (Urinary Tract Infection: UTI) is effective Oct. 1, 2017.
The UTI is coded on the MDS only if both the following criteria are met in the last 30 days:
- It is determined that the resident has a UTI using evidence-based criteria such as McGeer, NHSN, or Loeb in the last 30 days,
- A physician-documented UTI diagnosis in the last 30 days.
The RAI User’s Manual further states that providers must use a tool that is linked to their Infection Prevention and Control Program.
McGeer evidenced-based UTI Criteria for patients without an indwelling catheter:
The MDS coding of UTI is supported if one of the three following criteria are present in combination with positive laboratory findings of at least 105 cfu/ml of no more than 2 microorganisms per voided specimen or at least 102 cfu/ml of any number of organisms in a specimen collected via in and out catheterization.
One of the 3 below with positive lab findings:
- Acute dysuria or acute pain swelling or tenderness of the testes, epididymis or prostate, alone
- Fever (temperature of 100°F (38°C) or 2.4 degrees above the patient’s baseline temperature) and at least one new or worsening of the following:
- • Urgency
• Suprapubic Pain
• Gross Hematuria
• Back or Flank Pain
• Urinary Incontinence
- • Urgency
- In the absence of a fever, two or more of the above symptoms identified in number
Please note that there is a separate McGeers criteria for patients with an indwelling catheter.
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