Improving Blood Culture Sensitivity WHEN AND WHY Blood ...
Improving Blood Culture Sensitivity WHEN AND WHY Blood ...
Improving Blood Culture Sensitivity WHEN AND WHY Blood ...
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Examples<br />
• DRG 871 & 872 (Sepsis) $6,500-$12,000<br />
• DRG 864 (Fever unknown origin) $4,500-$5,500<br />
• DRG 690 (Urinary tract infection) $4,000-$5,000<br />
• DRG 795 (Pneumonia) $4,000-$5,000<br />
Afebrile sepsis with false negative blood culture costs THOUS<strong>AND</strong>S!<br />
Quickie Financial Impact Study<br />
• Count the number of DRG 871’s and 872’s<br />
(sepsis) and multiply by the reimbursement<br />
amounts for a given period of time in your<br />
hospital.<br />
• Approximately half of the patients properly<br />
coded as septic could not have been done so<br />
without a positive blood culture.<br />
• Impress your lab manager, CEO, CFO’s with the<br />
big bucks generated by Microbiology and be a<br />
financial hero!!<br />
Critical Point<br />
• Physician must document sepsis in discharge summary<br />
for hospital to receive sepsis diagnosis.<br />
• Concurrent review – DRG coders review charts daily for<br />
reimbursable diagnoses and work with physicians on<br />
documentation. ti Microbiology lab intervention ti not<br />
needed.<br />
• Retrospective review – DRG coders do not receive chart<br />
until discharge.<br />
• DRG coders must contact physician to rewrite discharge<br />
summary if sepsis not acknowledged – Very Problematic<br />
Easy Fix<br />
• When blood culture turns positive for significant<br />
pathogen immediately photocopy and give to<br />
coder.<br />
• Coder then goes to floor, checks chart for proper<br />
documentation.<br />
• If necessary, coder works with physician to<br />
improve documentation prior to discharge.<br />
• Keep financial stats, score points with CEO/CFO<br />
for quantitative good deeds.<br />
Buggy Bingos<br />
(Retrospective Review Hospital)<br />
• Microbiology – coder interaction obtains<br />
more money for hospital.<br />
Double Buggy Bingos<br />
• Microbiology-coder-doctor interaction both<br />
improves outcome and optimizes<br />
reimbursement.<br />
Medical Value of a<br />
Negative <strong>Blood</strong> <strong>Culture</strong><br />
• Means that bloodstream has not been invaded<br />
and prognosis is good.<br />
• If patient has abdominal complaint, means that<br />
patient may be able to be managed medically,<br />
instead of surgically.<br />
• Supports decision to switch from IV or IM<br />
antibiotics to oral antibiotics.<br />
• Supports decision to allow patient to be<br />
discharged.<br />
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