The long-stay UTI measure counts residents whose target assessment codes a urinary tract infection at I2300. Most active diagnoses in Section I look back 7 days. I2300 looks back 30. That window, and which assessment CMS picks as the target, decide whether a UTI lands in your quarter.
It is CMS measure N024.02, built only from the MDS, and it is one of the long-stay measures in the Five-Star quality rating.
Who is counted
The denominator is every long-stay resident with a target assessment. Long stay means 101 or more cumulative days in the facility in the current episode. Two things take a resident out:
- The target assessment is an OBRA admission assessment (A0310A = 01) or a PPS 5-Day (A0310B = 01).
- I2300 is dashed on the target assessment.
The numerator is one item on one assessment:
“Long-stay residents with a selected target assessment that indicates urinary tract infection within the last 30 days (I2300 = [1]).”
There is no risk adjustment. A building that takes residents at high risk of UTI is compared on the same scale as one that doesn’t.
What has to be true to code I2300
The RAI Manual sets two conditions, and both have to fall inside the same 30 days:
“Code only if both of the following are met in the last 30 days: 1. It was determined that the resident had a UTI using evidence-based criteria such as McGeer, NHSN, or Loeb in the last 30 days, AND 2. A physician documented UTI diagnosis (or by a nurse practitioner, physician assistant, or clinical nurse specialist if allowable under state licensure laws) in the last 30 days.”
The criteria are not a free choice for each case. The manual expects you to use the same nationally recognized criteria your infection prevention and control program already uses for surveillance. If your program runs on the updated McGeer criteria, I2300 is judged by McGeer too.
Two situations the manual handles separately:
- Diagnosed before the resident came in. If a physician diagnosed the UTI before admission, entry or reentry, you don’t have to re-check the criteria the other setting used. The documented diagnosis, for example in the hospital transfer summary, is enough. It still has to fall within the 30 days.
- Sent out but not admitted. After an emergency room visit or an observation stay, the facility has to apply its own criteria to the resident and confirm there is a physician-documented diagnosis. An ER discharge sheet that says “UTI” is not enough on its own.
The 30 days, in dates
The look-back counts back from the ARD, and the ARD itself is day 1:
“The ARD (item A2300) is the last day of the observation/look-back period, and day 1 for purposes of counting back to determine the beginning of observation/look-back periods.”
A worked example. Resident A meets the facility’s UTI criteria on March 3, and the physician documents the diagnosis the same day. An assessment with an ARD of April 1 looks back to March 3, so I2300 is coded. An assessment with an ARD of April 2 looks back only to March 4, so it is not.
If the criteria and the diagnosis land on different days, the window has to hold both. Whichever came first is the one that falls out of the window first.
Which assessment counts: the target
Unlike falls, the UTI measure reads one assessment, not a history. For each resident, CMS takes the latest qualifying assessment in the resident’s episode, as long as its date is no more than 120 days before the end of the episode (a discharge, or the end of the quarter). Qualifying means an OBRA assessment, a PPS 5-Day or an OBRA discharge. The target does not have to fall inside the quarter itself.
So a coded UTI counts in each quarter where that assessment is the resident’s latest one.
- It doesn’t drop off by itself. If no later assessment is done, the one that coded the UTI stays the target, and it counts.
- The next assessment decides. If the resident’s next assessment, a quarterly for example, has an ARD 30 or more days after the criteria and diagnosis, the UTI isn’t on it. That assessment becomes the target.
- The ARD still has to be right. It has to fall inside the assessment’s required window and reflect the resident. Knowing the look-back date helps you schedule with it in mind. It is not a reason to move an assessment outside the rules.
See your building’s UTI rate against the nation, free.
Common coding mistakes
- A lab result without the criteria. An abnormal urinalysis or culture is not the test. The test is your facility’s surveillance criteria applied to the resident, plus the physician’s diagnosis.
- Treatment without a diagnosis. An antibiotic started “for possible UTI” while waiting on a culture isn’t a documented UTI diagnosis. If the culture and assessment rule it out, I2300 stays unchecked.
- Using the 7-day rule. I2300 is the one item in Section I that doesn’t use the 7-day active-diagnosis look-back. A UTI treated and resolved three weeks before the ARD is still coded if both conditions fall within the 30 days.
- An old diagnosis carried forward. A diagnosis list that still shows “UTI” from two months ago doesn’t meet the rule. Both conditions have to be in the last 30 days.
What supports the code: the infection surveillance record showing which criteria were met and when, and the physician’s note with the diagnosis and its date. Keep them where the MDS coordinator can see both.
How Five-Star scores it
UTI is a 100-point measure. Buildings are split into fifths on the national distribution, and the rate used is the average of the four most recent quarters, weighted by each quarter’s denominator. A building needs at least 20 assessments across those four quarters; below that, CMS fills the gap with the state average.
| Four-quarter UTI rate | Five-Star points |
|---|---|
| 0% to 0.70% | 100 |
| 0.71% to 1.60% | 80 |
| 1.61% to 2.72% | 60 |
| 2.73% to 4.52% | 40 |
| 4.53% and up | 20 |
The bands are narrow. A building averaging 80 long-stay residents a quarter has about 320 target assessments over four quarters. Two coded UTIs in that year is 0.63% and 100 points; a third is 0.94% and 80 points.
SuperQM shows each coded UTI next to the date its 30 days run out, so the next assessment can be planned with that date in view.
Sources
- CMS, MDS 3.0 Quality Measures User’s Manual v18.0 (effective January 1, 2026), Chapter 1 and Table 2-21
- CMS, MDS 3.0 RAI User’s Manual v1.20.11 (effective October 1, 2026), Chapter 2 and Section I
- CMS, Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, September 2026, Appendix Table A3
