Q&A: Nephrostomy tube catheter associated infection and HACs

CDI Strategies - Volume 15, Issue 50

Q: Code T83.512, Nephrostomy tube catheter associated infection, leads to DRG 698-700. I understand this is not considered a hospital acquired condition (HAC), but is it still a catheter associated infection from a device?

A: HACs are a specific group of complication codes identified by CMS as being preventable, high-cost complications. There are hundreds of other codes that describe a device-related infection that do not trigger a HAC, even if identified as being not present on admission (POA).

Physicians often get confused and think any diagnosis identified as not POA will trigger a HAC, but that’s not the case.

The codes that trigger a HAC can be found here.

Remember there are two HAC programs. The original POA/HAC program identifies the following conditions:

  • Stage III and IV pressure ulcers
  • Air embolism following infusion
  • Foreign object retained following surgery
  • Falls and trauma
    • Fractures
    • Dislocations
    • Intracranial injuries
    • Crushing injuries
    • Burns
    • Other injuries
  • Blood incompatibility
  • Catheter associated urinary tract infections (CAUTI)
  • Vascular catheter associated infections
  • Manifestations of poor glycemic control
    • Diabetic ketoacidosis
    • Non-aortic hyperosmolar coma
    • Hypoglycemic coma
    • Secondary diabetes with ketoacidosis
    • Secondary diabetes with hyperosmolarity
  • Deep vein thrombosis (DVT)/pulmonary embolism (PE) following certain orthopedic procedures
    • Total knee replacement
    • Hip replacement
  • Introgenic pneumothorax with venous catheterization
  • Surgical site infection following
    • Cardiac implantable electronic device
    • Certain orthopedic procedures of elbow, shoulder, and spine
    • Bariatric surgery
    • Mediastinitis following CABG

The second HAC program is called the HAC Reduction Program (HACRP). The HACRP applies a 1% payment reduction to hospitals that rank in the lowest performing quartile of all subsection hospitals with respect to the occurrence of HACs that appear during an applicable program. This new program builds on the progress in this area achieved through the existing HAC program (it does not replace the current program).

The HACRP has two domains of measure sets:

  • Domain 1: Composite patient safety indicator (PSI) 90
    • PSI 90 is an administrative claims-based measure developed by the Agency for Healthcare Research and Quality (AHRQ)
    • PSI 90 is a composite of eight individual measures:
      • PSI 03: Pressure ulcer
      • PSI 06: Iatrogenic pneumothorax
      • PSI 08: In hospital fall and hip fracture rate
      • PSI 09: Perioperative hemorrhage and hematoma rate
      • PSI 10: Postoperative acute kidney injury rate
      • PSI 11: Postoperative respiratory failure rate
      • PSI 12: Postoperative PE or DVT
      • PSI 13: Postoperative sepsis
      • PSI 14: Postoperative wound dehiscence
      • PSI 15: Accidental puncture or laceration
  • Domain 2: Hospital acquired infection measures developed by the Centers for Disease Control and Prevention’s National Health Safety Network (CDC NHSN)
    • Central line associated blood stream infection (CLABSI)
    • CAUTI
    • MRSA bacteremia
    • C-difficle

Q: Do we need to memorize all of the HACs for the CCDS exam?

A: I cannot tell you what specific questions on the exam pertain to HACs, however, you should have a clear understanding of who makes the decisions regarding which conditions are HACs, the definition of a HAC, their influence on some of CMS’ programs, and how they affect reimbursement.

Take a look at the breakdown of question types in the Certification Exam Candidate’s Handbook (available for free on the ACDIS website). It will tell you the areas covered in the exam and the number of questions that pertain to each area. That should help you focus your study time.

Editor’s Note: Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, CDI education director at HCPro, answered this question. For information regarding CDI Boot Camps, click here. This article originally ran in May 2019 and has been updated according to all new coding and documentation guidelines.

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