#Presence of foley catheter icd 10 code#
These catheter infections, which code to 996.64, are potential quality issues.Ĭoders must not assume that every documentation of “urinary tract infection due to catheter” automatically assigns to code 996.64. This may be a urethral catheter such as a Foley or it may be a suprapubic catheter if the patient’s medical condition requires this type of insertion.
The index and tabular of ICD-9-CM are specific that the line must be indwelling (ie, left in place in the bladder). Not all urinary catheters qualify as HACs. To correctly code and report a patient’s condition, the physicians’ documentation must validate the site and type of catheter, that the infection was caused by the catheter, and whether the diagnosis or its symptoms were present on admission. While there is more than one code for each of these diagnoses, only codes 999.31 (Infection and inflammation due to an indwelling urinary catheter) and 996.64 (Infection and inflammation due to central venous catheter) are reportable. Two of the most widely reported HACs are vascular and urinary catheter infections. If the removal of a code reduces the DRG, then the associated payment is lowered accordingly.īecause this issue affects everyone from coding managers and quality staff to chief financial officers and the CMS itself, let’s examine some of the reasons these conditions are difficult to code. Anyone can access the resulting Hospital Compare website and review comparison data on the HAC measures for any three participating inpatient facilities in proximity to each other.Įvery time a claim is sent to Medicare or Medicaid, the DRG is recalculated after removing any HAC diagnosis codes that were either not present on admission or were unknown if present on admission. In addition, as part of the adoption of the fiscal year 2011 Inpatient Prospective Payment System final rule, the Centers for Medicare & Medicaid Services (CMS) announced eight of the 10 HACs will be included in the Hospital Inpatient Quality Reporting program. Beginning July 1, nine of them will have the potential to affect Medicaid payment. Since October 2008, each has had the potential to affect Medicare DRG payment on individual inpatient claims. The current list of HACs features 10 conditions.
Section 5001(c) of the Deficit Reduction Act of 2005 mandates that Health and Human Services (HHS) identify hospital-acquired conditions (HACs) that are high cost, high volume, or both result in the assignment of the case to a diagnosis-related group (DRG) that has a higher payment when present as a secondary diagnosis and could reasonably have been prevented through the application of evidence-based guidelines.
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