Improving Blood Culture Sensitivity WHEN AND WHY Blood ...

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