Is it reasonable to apply ICD-10 coding diagnoses to identify healthcare associated urinary tract infections?

Miss Karen Maglinao1, A/Prof Caroline Marshall1

1Melbourne Health, Parkville, Australia

 

Introduction: Australian healthcare services will now be required to monitor Healthcare-Associated Complications (HACS), which include a number of healthcare-associated infections. A diagnosis of HAC will be made using ICD-10 coding diagnoses documented in patient medical records. This study compared these diagnoses of healthcare associated urinary tract infections (HAUTI) with surveillance criteria as the gold standard to examine accuracy.

Methods: We compared designation of HAUTI according to ICD-10 codes with diagnoses using Centers for Disease Control National Healthcare Safety Network (CDC-NHSN) criteria for HAUTI and catheter-associated UTI (CAUTI). Coding uses diagnoses recorded by clinicians in the patient medical records with some corroborating information. CDC-NHSN definitions use strict criteria including time since admission, symptoms and culture results to assign a diagnosis of HAUTI.

Results: Eighty-four patients with an ICD-10 code of HAUTI with admission dates between 1 December 2016 and 28 February 2017 were reviewed and compared with a diagnosis using CDC-NHSN criteria. Of the 84 patients, 56 (67%) were considered HAUTI, 12 (14%) were UTI present on admission, 15 (18%) had no UTI and one patient had no information in the system. 37 of the 56 patients with HAUTI had IDCs in situ but only 16 met the CDC-NSHN CAUTI criteria.

Conclusion: We found that only 67% of HAUTI diagnoses using ICD-10 criteria were correlated with HAUTI using CDC-NHSN criteria, suggesting that using ICD-10 coding may not present a true rate of HAUTI. Coding methods cannot be easily changed. Improving documentation in medical notes may improve accuracy.

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