Q:
One of the residents at my facility was sent out to the hospital in the afternoon and returned to the facility later that evening during the 30-day look-back for my MDS. On reviewing the ED paperwork, I saw that she was diagnosed with a UTI. Because this diagnosis came from the hospital, I understand that I do not need to find support for the McGeer criteria to code this at I2300. Is that correct?
A:
At the root of your question is the requirement that a UTI diagnosis be determined using evidence-based criteria, such as McGeer, NHSN or Loeb (RAI I-14). The RAI manual clarifies: “If the diagnosis of UTI was made prior to the resident’s admission, entry, or reentry into the facility, it is not necessary to obtain or evaluate the evidence-based criteria used to make the diagnosis in the prior setting” (RAI, p. I-15, bold in original). This is what many people reference when they say the facility does not need to verify criteria for a hospital diagnosis.
However, this guidance generally assumes the resident was admitted to the hospital and then reentered the facility. In the scenario presented above, the resident was evaluated in the ED but was not admitted. In this situation, the RAI manual further states: “When the resident is transferred, but not admitted, to a hospital (e.g., emergency room visit, observation stay) the facility must use evident-based criteria to evaluate the resident and determine if the criteria for UTI are met AND verify that there is a physician-documented UTI diagnosis when completing I2300 Urinary Tract Infection (UTI).” (Ibid.).
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Written By:
Chris Calo, RN, RAC-CT
MDS Consultant
Proactive LTC Consulting
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