CCDS POA and Hospital-Acquired Conditions (HACs) 5 — Questions and Answers
Question 1: Which of the following conditions is NOT included in the CMS list of Hospital-Acquired Conditions subject to the HAC payment provision?
- Vascular catheter-associated infection
- Falls and trauma resulting in certain fractures
- Community-acquired Clostridioides difficile infection (Correct answer)
- Surgical site infection following bariatric surgery
Correct answer: Community-acquired Clostridioides difficile infection
Community-acquired C. difficile infection is present on admission and is not a HAC; only hospital-acquired C. difficile is included in the HAC list.
Question 2: A diabetic patient is admitted for elective knee replacement. Preoperative glucose is 280 mg/dL. On post-op day 2, blood glucose rises to 310 mg/dL. How should POA be assigned for hyperglycemia?
- Y, because the patient had diabetes and elevated glucose before admission (Correct answer)
- N, because the elevated glucose occurred post-operatively
- U, because there is insufficient documentation
- W, because it is clinically undeterminable
Correct answer: Y, because the patient had diabetes and elevated glucose before admission
The underlying diabetes and elevated glucose were clinically present before admission, so hyperglycemia receives a POA indicator of 'Y'.
Question 3: Under ICD-10-CM POA reporting guidelines, which category of codes is EXEMPT from POA indicator reporting?
- External cause codes (Correct answer)
- Principal diagnosis codes
- Secondary diagnosis codes that affect DRG assignment
- Codes for chronic conditions
Correct answer: External cause codes
External cause codes (V, W, X, Y codes) are exempt from POA indicator reporting per ICD-10-CM official guidelines.
Question 4: A patient is admitted from a skilled nursing facility (SNF) with a stage 3 pressure injury on the sacrum. The SNF transfer documentation confirms the injury pre-existed admission. What POA indicator should be assigned?
- Y (Correct answer)
- N
- U
- W
Correct answer: Y
A stage 3 pressure injury documented and confirmed as present before the current hospital admission receives POA indicator 'Y'.
Question 5: Which of the following best describes the 'POA exempt' status of a HAC on the CMS HAC list?
- The HAC is excluded from all quality reporting programs
- The MS-DRG payment is not adjusted even if the condition is not POA (Correct answer)
- CMS exempts the hospital from reporting the HAC to the state
- The condition cannot be coded as a secondary diagnosis
Correct answer: The MS-DRG payment is not adjusted even if the condition is not POA
When a HAC is designated as POA exempt, CMS will not adjust the MS-DRG payment even if the condition was not present on admission.
Question 6: During a concurrent review, a CDIS notes the physician documented 'acute respiratory failure' on hospital day 3 with no mention in the H&P. The patient was admitted for COPD exacerbation. What should the CDIS do?
- Assign POA indicator 'Y' because COPD was present on admission
- Query the physician to clarify whether the acute respiratory failure was present on admission (Correct answer)
- Assign POA indicator 'N' because it was documented after admission
- Leave the POA indicator blank as it is a complication of a POA diagnosis
Correct answer: Query the physician to clarify whether the acute respiratory failure was present on admission
A CDIS should query the physician to clarify clinical timing before assigning a POA indicator for a condition first documented after admission.
Question 7: A hospital receives a RAC (Recovery Audit Contractor) audit finding that a HAC was incorrectly assigned POA indicator 'Y' when clinical evidence supported 'N.' What is the primary financial risk to the hospital?
- Loss of Joint Commission accreditation
- Recoupment of the MS-DRG overpayment received (Correct answer)
- Mandatory reporting to the Office of Inspector General
- Exclusion from the Medicare program
Correct answer: Recoupment of the MS-DRG overpayment received
If a RAC finds that a HAC should have been POA 'N,' the hospital faces recoupment of any overpayment because the MS-DRG would have been lower.
CCDS POA and Hospital-Acquired Conditions (HACs) 5
Which of the following conditions is NOT included in the CMS list of Hospital-Acquired Conditions subject to the HAC payment provision?