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| It's Coming!The National Uniform Billing Committee has approved a new data element of Present on Admission (POA) Indicator. Present on Admission is defined as present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered as present on admission. What does this mean? This means that unless you thoroughly document in your history and physical that a patient has a history of a condition, or list potential diagnosis in your differential, the hospital may not be reimbursed for conditions you treat that come up during the patients hospital stay. Why should you care? The POA will be mandated in Maryland, and has potential for national implementation for Deficit Reduction Act (DRA) requirements for hospital acquired infections. The DRA of 2005, section 5001 Hospital Quality Improvement states that reduction in payment to hospitals in some cases when the patient acquires an infection during a hospital stay. New York and California have already implemented these rules. Florida, Illinois, Maryland and Massachusetts are going to implement sometime in 2007. The rules apply to diagnosis codes for claims involving inpatient admissions to general acute-care hospitals or other facilities as required by law or regulation for public health reporting. More specifically, it applies to principal and secondary diagnosis. The POA indicator may be effective starting 3/1/07, and DRA requirement starting with discharges on or after 10/1/07, affecting payment on 10/1/08. Here are some examples to help you better understand the POA. A patient with known congestive heart failure is admitted to the hospital after he develops decompensated congestive heart failure. The congestive heart failure is POA and codable. A patient with diabetes mellitus developed uncontrolled diabetes on day three of the hospitalization. Uncontrolled diabetes would be flagged as not present on admission which will potentially reduce payment for the hospital. A patient is admitted with high fever and pneumonia. The patient rapidly deteriorates and becomes septic. The discharge diagnosis lists sepsis and pneumonia. The documentation is unclear as to whether the sepsis was present on admission or developed shortly after admission. So the physician assistant will be queried as to whether the sepsis was present on admission, developed shortly after admission, or cannot be clinically determined as to whether it was present on admission or not. Patient is admitted in active labor. After 12 hours of labor it is noted that the infant is in fetal distress and a Cesarean section is performed. The delivery is codable, but the fetal distress would be flagged as not present on admission which will potentially reduce payment for the hospital. A patient undergoes outpatient surgery. During the recovery period, the patient develops atrial fibrillation and the patient is subsequently admitted to the hospital as an inpatient. The atrial fibrillation is codable since it developed prior to a written order for inpatient admission. All the material documented here came from Coding Clinic Fourth Quarter 2006 Appendix I, and AHA Central Office audio conference “Present on Admission Indicators & DRG Update”. Please see your coding staff for further explanations. |