Coding for Superbugs

by | Published on Dec 7, 2012 | Medical Coding

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A “superbug” doing the rounds had claimed its 7th victim last month, following the six patients who died last year from complications that resulted from the infection known as KPC (Klebsiella pneumoiae carbapenemases) that is resistant to carbapenem antibiotics. The outbreak was consequent to a patient with pulmonary alveolar proteinosis, a rare lung condition, being transferred to NIH for research studies. She was found to be infected with carbapenem resistant K. pneumonia, and in the ICU the infection spread to two other patients. The infection spread to eighteen patients ultimately. However, the NIH was able to control the infection.

Considering coding for a superbug, the coder has to select the correct diagnosis codes and list them in the proper order. They have to pay attention to 2 important areas – HAC (Hospital Acquired Conditions) and POA (Present on Admission) reporting. The coder has to correctly identify and report the principal diagnosis. In the above case, the patient’s lung condition is to be reported as the principal diagnosis, whereas the infection Klebsiella pneumonia will be the secondary diagnosis.

It is mandatory for hospitals to report Present on Admission information for primary as well as secondary diagnoses. For this case, the woman’s diagnosis has to be identified as Present at the Time of Admission because she was already known to be infected with KPC. Another interesting question with regard to this incident is whether the infections at NIH were preventable. CMS uses policies such as Preventable Hospital Acquired Conditions including infection to improve quality and efficiency of care for patients in hospitals. The same DRG payment is given to hospitals for inpatient cases that vary in services and length of stay. This is to ensure that hospitals treat patients well and keep away unnecessary costs and complications. The policy enables CMS to avoid paying a higher rate for treating preventable hospital acquired conditions. In the case discussed above, if it is proved that the infections in the 2 other patients in the ICU were preventable, CMS will not reimburse the hospital’s services for them.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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