Documentation
Valid or Invalid
Valid or Invalid
Patient lives in permanent long-term assisted living facility.
Invalid - patient lives in a nursing home, not a nursing facility. Nursing facilities are short term.
True or False: A4353 is ONLY covered during pregnancy for females who have both a spinal cord injury and neurogenic bladder.
True
The spinal cord injury (SCI) qualifier for A4353 has two parts. Name those two parts.
Spinal cord injury diagnosis and location
A beneficiary would be considered to have a urinary tract infection if they have a urine culture with greater than how many colony forming units?
10,000
Culture Date: June 3, 2022 - patient reports a fever of 102.4 F
Culture Date: June 15, 2022 - Increased muscle spasms due to UTI
Shipped 51's and lubricant packets on May 27, 2022 - so good sterile proof
Invalid - culture dates are not 2 weeks apart
This five letter word describes the length of stay in a nursing facility.
Short
True or False: Documentation for A4353 showing cancer chemotherapy must include length of need.
True: cancer chemotherapy is not permanent so we must know the length of need because the patient can only receive the A4353's during chemotherapy.
The presence of a concurrent symptom must be within how long of the urine collection date in order to be valid?
One week or 7 days (will except either)
Components Value Ref Range
Red Blood Cells 3-5 0-5/HPF
White Blood Cells 13-19 0-5/HPF
Bacteria, Urine 2+ None/HPF
Valid - patient has Pyuria and the white blood cell count is greater than 5. HPF indicates urinalysis.
In order for a patient to qualify for A4353's with the nursing facility qualifier, what type of documentation is required?
Length of Need
Immunosuppression is one of the qualifiers for A4353. Name at least TWO different ways a patient can be immunosuppressed.
Regimen of immunosuppressive drugs post-transplant
Cancer chemotherapy
AIDS/HIV
Chronic oral corticosteroid use
Spinal Cord Injury (SCI)
True or False: A culture is considered valid if it shows urogenital flora.
False: Urogenital or mixed urogenital flora is a sign of contamination and is unacceptable.
History of Present Illness
74-year-old tetraplegic male with past medical history of C6 AIS-D TSCI secondary to MVC complicated by neurogenic bladder/bowel after suffering fall at home.
Valid - C6 is the location of SCI and AIS-D TSCI is the diagnosis (AIS-D is the ASIA impairment scale and TSCI is traumatic spinal cord injury)
What is Vesico-Ureteral Relux?
A condition in which urine moves backwards from the bladder into the ureters and kidneys.
What documentation is required for a patient to qualify for A4353 who is on a regimen of immunosuppressive drugs post-transplant?
Organ that received the transplant
Name of immunosuppressive drug
LON (only for bone marrow transplant as organ transplants are permanent)
What is Pyuria?
A condition in which you have high levels of white blood cells or pus in your urine. (Must include in urine)
History: 50 year old male with MS presents with c/o Dysuria before and after urination. PT self caths and has a history of bladder infections. His urine is cloudy.
Current Medications:
Vitamin D - 1 capsule by month twice weekly
Prednisone - 1 delayed release tablet daily
Aspirin - as needed
Invalid - docs missing length of need (LON)
What are the two types/causes of vesico-ureteral reflux?
Primary VUR: birth defects in one or both ureters
Secondary VUR: blockage in the urinary tract obstructs the flow of urine and sends it back into the kidneys
In order to qualify for A4353's with the spinal cord injury (SCI) qualifier, the patient must have a spinal cord injury located where?
Between C1-T3
On what date did Medicare change their UTI qualifications from requiring a patient to use "clean" technique to using "sterile" technique?
April 1, 2008