Present on Admission (POA) Indicators Final Exam.

Present on Admission (POA) Indicators Final ExamPresent on Admission (POA) Indicators - answermandated by the Deficit Reduction Act on 10/01/07. Must report all diagnoses that are POA so it can differentiate between ones that developed during the patient's admission. If it was not POA, there will not be any reimbursement. CMS will no longer reimburse for extra costs incurred from certain hospital-acquired conditions (HACs). This is applicable to hospitals that are reimbursed under IPPS (Inpatient Prospective Payment System). Some hospitals are exempt. Types of hospitals that are exempt from POA indicators: - answer**Cancer Hospitals **Childrens Inpatient Facilities **Rural Health Clinics **Federally Qualified Health Clinics **Religious non-medical Healthcare Institutions **Inpatient Psych. Hospitals **Inpatient Rehab. Hospitals **VA and DOD Hospitals Reporting Definitions for POA - answerY-present on admission N-not present at time of admission U-documentation insufficient to determine W-provider unsure/unable to determine if condition(s) were POA Unreported/Not Used-some codes are exempt, electronic claims will have a "1" in the POA field Conditions diagnosed prior to inpt. admission - answerassign Y Conditions diagnosed during the admission, but clearly present before admission - answerassign Y Condition that develops during an outpatient encounter prior to inpt. admission - answerassign Y If documentation is not present - answerassign U **try to figure it out if possible. U is a red flag for CMS!** Cannot be determined whether condition was or was not POA - answerassign W Chronic condition with acute exacerbation during admission (combination codes) - answerIf any part of the combination code was NOT POA assign N If ALL parts of the combination code were POA assign Y If combination code only identifies the chronic condition (if condition is chronic, pt has had it a long time, this obviously make is POA) - answerassign Y If diagnosis includes comparitive/contrasting diagnoses and all were present or suspected at time of admission - answerassign Y Infection codes that include the causal organism of the infection, or if signs of infection were POA - answerassign Y (even if cultures results are not back yet) Conditions that are probable, suspected, etc. - answerassign Y Signs and Symptoms not POA - answerassign N Conditions documented as impending or threatened at time of d/c - answerassign Y if dx is based on symptoms of clinical findings, if not, assing N Acute and Chronic - answerassign Y for acute POA assign N for acute not POA assign Y for chronic even if it isn't diagnosed until after admission Obstetrical conditions - answerWhether or not the patient delivers during the current hospitalization does not affect assignment of the POA indicator. The determining factor for POA assignment is whether the pregnancy complication or obstetrical condition described by the code was present at the time of admission or not. If the pregnancy complication or obstetrical condition was POA (ex. patient admitted in preterm labor) - answerassign Y If the pregnancy complication or obstetrical condition was not POA (ex. 2nd degree laceration during delivery, postpartum hemorrhage that occurred during current hospitalization, fetal distress develops after admission) - answerassign N If the obstetrical code includes more than one diagnosis and any of the diagnoses identified by the code were not POA (ex. Code 642.7, Pre-eclampsia or eclampsia superimposed on preexisting hypertension) - answerassign N Any condition present at birth or that developed in utero is considered POA, This includes conditions that occur during delivery - answerassign Y For congenital conditions and anomalies - answerassign E **Congenital conditions are always considered POA and have been identified as exempt Any E code representing an external cause of injury or poisoning that occurred prior to inpatient admission (External cause of injury codes) - answerassign Y Any E code representing an external cause of injury or poisoning that occurred during inpatient hospitalization (External cause of injury codes) - answerassign N Categories and Codes Exempt from Diagnosis Present on Admission Requirement - answerNote: "Diagnosis present on admission" for these code categories are exempt because they represent circumstances regarding the healthcare encounter or factors influencing health status that do not represent a current disease or injury or are always present on admission. Categories or subcategories listed are inclusive of all codes within those categories or subcategories, unless otherwise indicated. In order to streamline the POA exempt list and make it easier to read, where all of the codes in a code range are POA exempt, only the code range is shown, rather than listing each of the individual codes in the range. 137-139, Late effects of infectious and parasitic diseases 268.1, Rickets, late effect 326, Late effects of intracranial abscess or pyogenic infection 412, Old myocardial infarction 438, Late effects of cerebrovascular disease 650, Normal delivery 660.7, Failed forceps or vacuum extractor, unspecified 677, Late effect of complication of pregnancy, childbirth, and the puerperium 740-759, Congenital anomalies 905-909, Late effects of injuries, poisonings, toxic effects, and other external causes V02, Carrier or suspected carrier of infectious diseases V03, Need for prophylactic vaccination and inoculation against bacterial diseases V04, Need for prophylactic vaccination and inoculation against certain viral diseases V05, Need for other prophylacti .