Free CCDS POA and Hospital-Acquired Conditions (HACs) Questions and Answers 1 — Questions and Answers
Question 1: A patient develops a catheter-associated urinary tract infection (CAUTI) on the third day of their hospital stay. What is the correct Present on Admission (POA) indicator for this diagnosis?
- Y (Yes, present on admission)
- N (No, not present on admission) (Correct answer)
- U (Unknown, documentation insufficient)
- W (Clinically undetermined)
Correct answer: N (No, not present on admission)
The POA indicator 'N' signifies that the condition was not present at the time of inpatient admission. Since the CAUTI developed after admission, 'N' is the correct indicator.
Question 2: Which of the following conditions is on the CMS list of Hospital-Acquired Conditions (HACs) that can lead to a payment reduction if not POA?
- Ventilator-associated pneumonia
- Acute myocardial infarction occurring post-operatively
- Falls and trauma (e.g., fracture) acquired during the stay (Correct answer)
- Community-acquired pneumonia
Correct answer: Falls and trauma (e.g., fracture) acquired during the stay
The CMS HAC list includes specific, preventable conditions. A fall and trauma, such as a fracture or dislocation, that occurs after admission is a listed HAC, as are Stage 3 and 4 pressure ulcers and certain surgical site infections.
Question 3: What is the financial impact to a hospital if a patient acquires a Stage 3 pressure ulcer (a HAC) during their stay?
- The hospital receives a quality bonus.
- The entire claim is denied.
- The DRG is paid as if the HAC was not present. (Correct answer)
- There is no financial impact, it only affects quality scores.
Correct answer: The DRG is paid as if the HAC was not present.
Under the HAC Reduction Program, if a condition on the HAC list is acquired during the stay (POA = N or U), the DRG is recalculated for payment as if that secondary diagnosis were not present. This typically results in assignment to a lower-weighted and lower-paying DRG.
Question 4: A patient is admitted from the emergency department with sepsis. The admission note does not mention acute kidney injury (AKI), but labs drawn in the ED show an elevated creatinine. AKI is first diagnosed on day 2. What is the likely POA status of the AKI?
- Y (Yes) (Correct answer)
- N (No)
- U (Unknown)
- W (Clinically Undetermined)
Correct answer: Y (Yes)
The POA indicator applies to conditions present at the time of the inpatient admission order. Since the clinical indicators (elevated creatinine) were present from the ED visit immediately preceding admission, the AKI was present on admission, even though it was not diagnosed until later. The correct POA is 'Y'.
Question 5: When is it appropriate for a coder to assign the POA indicator 'U' (Unknown)?
- When the physician documents 'possible' for a diagnosis.
- When the documentation is insufficient to make a determination. (Correct answer)
- When a condition develops 24 hours after admission.
- When the physician explicitly writes 'POA unknown' in the chart.
Correct answer: When the documentation is insufficient to make a determination.
The 'U' indicator should be used as a last resort when the medical record documentation is insufficient to determine if the condition was present at the time of admission. This indicates a documentation gap that could not be clarified.
Question 6: What is the primary role of the CDS in ensuring accurate POA assignment?
- To assign the final POA indicators on the claim form.
- To tell the physician which POA indicator to document.
- To perform concurrent record review and query for clarification on the timing of diagnoses. (Correct answer)
- To diagnose conditions that were present on admission but missed by the physician.
Correct answer: To perform concurrent record review and query for clarification on the timing of diagnoses.
The CDS's main function is to improve the quality of clinical documentation. By performing concurrent reviews and querying physicians to clarify the onset, timing, and clinical indicators of conditions, the CDS ensures the record is clear for accurate POA assignment by the coder.
Free CCDS POA and Hospital-Acquired Conditions (HACs) Questions and Answers 1
A patient develops a catheter-associated urinary tract infection (CAUTI) on the third day of their hospital stay.
What is the correct Present on Admission (POA) indicator for this diagnosis?