Questions and Answers
Assign 'Y' or 'N' if all conditions represented by the single ICD-10-CM code were present on admission?
What is required by Section 5001(c) of the DRA?
To identify at least two conditions that have a high cost, high volume or both.
The delivery status of a patient affects the assignment of the POA indicator for obstetrical conditions.
False
The Hospital-Acquired Conditions payment provision applies only to Critical Access Hospitals.
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What should be assigned for any condition present at birth for newborns?
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What should be assigned for congenital conditions and anomalies (except Q00-Q99)?
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Assign 'Y' for external cause codes if they occurred during inpatient hospitalization.
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What does 'Present on Admission' (POA) refer to?
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What is the definition of Principal Diagnosis?
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What does a POA Indicator of 'Y' signify?
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What does the POA Indicator 'N' mean?
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When should a POA Indicator be assigned to conditions diagnosed prior to inpatient admission?
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If documentation is insufficient to determine if a condition was present at the time of inpatient admission, the POA Indicator is __________.
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What is the recommended action when a provider documents a condition as pending at the time of discharge?
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Match the POA indicators with their meanings:
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Explain the significance of the Healthcare provider's role in POA determination.
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The procedure performed for the definitive treatment of a condition is called the __________.
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The POA guidelines can be used to determine when a condition should be coded.
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Study Notes
Present on Admission (POA) Overview
- POA indicates if a condition was present at the time of inpatient admission.
- Essential for accurate coding and reimbursement in healthcare facilities.
Guidelines Introduction
- POA guidelines supplement ICD-10-CM coding standards.
- Facilitate the assignment of POA indicators for diagnoses on UB-04 and 837 Institutional claim forms.
- Consistent and complete documentation in medical records is crucial for accurate POA determination.
Definitions of Diagnoses
- Principal Diagnosis: The main condition responsible for the admission.
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POA Indicator:
- Y: Condition present upon admission.
- N: Condition not present upon admission.
- U: Documentation insufficient for determination.
- W: Clinically undetermined.
Coding Procedures and Documentation
- Conditions must be coded based on their timing: present at the time of admission or developed later.
- Medical record reviews must resolve any documentation inconsistencies.
- Any diagnosis ought to be explicitly documented by the provider regarding its status upon admission.
Reporting Requirements
- Inpatient admissions must report POA information as regulated.
- Outpatient conditions developing during healthcare encounters count as present on admission.
Grouping Diagnosis-Related Procedures
- MS-DRGs: Medicare severity diagnosis-related groups used for aligning payment with resource use.
- Proper grouper assignment necessitates validating principle diagnosis and associated conditions.
Special Cases:
- Pregnant patients: Assign POA based on obstetrical conditions present at the time of admission.
- Chronic conditions: Considered present if they exist before or not diagnosed until after admission but are documented as such.
Miscellaneous Codes and Assigning POA
- Certain conditions are exempt from POA reporting if specified by ICD-10-CM guidelines.
- Conditions identified with multiple clinical concepts require special attention for accurate POA assignment.
- If the same diagnosis code applies to multiple conditions, assess presence for all and assign POA accordingly.
Condition Development and HACs
- Hospital-acquired conditions (HACs) are not reimbursed if acquired after admission.
- Specific examples include pressure ulcers and surgical site infections.
Productivity Standards
- Establish benchmarks for chart coding efficiency: 3-4 inpatient, 5 same-day surgeries per hour.
Importance of Clear Documentation
- Clarifications through provider queries are critical when documentation does not specify whether conditions were POA.
- Documentation that indicates uncertainty should be assigned a "U" only in specific circumstances.
Exemptions and Unknowns
- Codes can be left blank or categorized as unreported if conditions naturally do not apply to the POA indicator.
- Proper training and adherence to coding guidelines are essential to avoid errors in POA assignments.### Hospital-Acquired Conditions (HAC) Exemptions
- HAC payment provision applies exclusively to Inpatient Prospective Payment System (IPPS) hospitals.
- Critical Access Hospitals (CAHs) are exempt from HAC payment provision.
- Long-Term Care Hospitals (LTCHs) do not fall under HAC payment requirements.
- Hospitals benefiting from Maryland Waiver are also exempt.
- Cancer Hospitals and Children's Inpatient Facilities are excluded from HAC provisions.
- Rural Health Clinics and Federally Qualified Health Centers (FQHCs) are exempt.
- Religious Non-Medical Health Care Institutions do not adhere to HAC payment provisions.
- Inpatient Psychiatric Hospitals and Inpatient Rehabilitation Facilities (IRFs) are likewise exempt.
- Veterans Administration and Department of Defense Hospitals are excluded from HAC policies.
POA Indicator - Perinatal Conditions
- Newborns are not admitted until after delivery; hence conditions at birth or developed in utero are marked present.
- Any condition occurring at birth receives a "Y" designation, including delivery-related injuries and meconium aspiration.
- Exposure to group B streptococcus during delivery is included under conditions assigned "Y."
POA Indicator - Congenital Conditions and Anomalies
- Congenital conditions and anomalies are always considered present at admission, assigned "Y."
- Exceptions exist for categories Q00-Q99, which are congenital anomalies on the exempt list.
POA Indicator - External Cause of Injury Codes
- Assign "Y" for external cause codes indicating morbidity prior to inpatient admission (e.g., falls at home).
- Assign "N" for external causes of morbidity occurring during hospitalization (e.g., fall from hospital bed).
- Adverse reactions to medications given after admission should receive an "N."
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Description
This quiz covers the Present on Admission (POA) reporting guidelines as detailed in Appendix I. It aims to enhance your understanding of the POA concept and its application in coding and reporting for inpatient admissions. Test your knowledge and familiarize yourself with the relevant definitions and guidelines.
