CCDS POA and Hospital-Acquired Conditions (HACs) 4 — Questions and Answers
Question 1: A patient is admitted with a stage 2 pressure injury on the coccyx that was documented as present on admission. Two days later, nursing documents a new stage 2 pressure injury on the right heel. What is the correct POA indicator for the heel pressure injury?
- Y – present on admission
- N – not present on admission (Correct answer)
- U – unknown if present on admission
- W – clinically undetermined
Correct answer: N – not present on admission
The right heel pressure injury developed after admission, making it not present on admission (N), which may trigger HAC payment implications.
Question 2: Which of the following CMS-designated HACs requires a POA indicator of 'N' to affect MS-DRG payment?
- Catheter-associated urinary tract infection (CAUTI) (Correct answer)
- Community-acquired pneumonia
- Chronic kidney disease stage 3
- Type 2 diabetes mellitus
Correct answer: Catheter-associated urinary tract infection (CAUTI)
CAUTI is a CMS-designated HAC, and when the POA indicator is 'N', it triggers the HAC payment adjustment.
Question 3: A physician documents 'possible aspiration pneumonia' in the H&P but does not confirm or deny it was present on admission. What POA indicator should be assigned?
- Y
- N
- U (Correct answer)
- W
Correct answer: U
When documentation is insufficient to determine whether a condition was present on admission, the POA indicator 'U' (unknown) is assigned.
Question 4: Under the HAC Reduction Program, hospitals in the worst-performing quartile for HAC rates receive what penalty?
- 1% reduction in total Medicare payments (Correct answer)
- 2% reduction in total Medicare payments
- 5% reduction in total Medicare payments
- 25% reduction in DRG payment for each HAC
Correct answer: 1% reduction in total Medicare payments
The ACA established a 1% reduction in total Medicare payments for hospitals in the worst-performing quartile under the HAC Reduction Program.
Question 5: A patient presents to the ED with left knee pain and is admitted. During the admission workup, an MRI reveals an occult fracture of the left femoral neck that was not previously diagnosed. What POA indicator applies?
- Y – condition existed before admission (Correct answer)
- N – condition arose after admission
- U – unknown
- W – clinically undetermined
Correct answer: Y – condition existed before admission
A condition that existed prior to admission, even if undiagnosed, is still considered present on admission and receives a POA indicator of 'Y'.
Question 6: Which POA indicator is used when the clinical documentation is insufficient to determine whether a condition was present on admission AND the physician cannot clinically determine if it was present?
- Y
- N
- U
- W (Correct answer)
Correct answer: W
POA indicator 'W' is used when the documentation is insufficient AND it is clinically impossible to determine if the condition was present on admission.
Question 7: A CDIS queries the physician about a central line-associated bloodstream infection (CLABSI) that developed on hospital day 5. The physician responds that it is 'likely hospital-acquired.' Which POA indicator is appropriate?
- Y
- N (Correct answer)
- U
- W
Correct answer: N
When a physician confirms the condition is hospital-acquired (arose after admission), POA indicator 'N' is appropriate, and it qualifies as a HAC.
CCDS POA and Hospital-Acquired Conditions (HACs) 4
A patient is admitted with a stage 2 pressure injury on the coccyx that was documented as present on admission.
Two days later, nursing documents a new stage 2 pressure injury on the right heel.
What is the correct POA indicator for the heel pressure injury?