ICD 10 Present on Admission (POA) Indicators and MS-DRG Reimbursement

Question 1

Which POA indicator means the condition was present when the inpatient admission occurred?

Accepted Answer

Y

Answer

Y = present at the time of inpatient admission. N = not present. U = documentation is not enough to decide. W = the provider cannot clinically determine it.

Question 2

A patient develops a condition in the emergency department and is then admitted as an inpatient. How is the condition reported for POA?

Accepted Answer

Present on admission (Y)

Answer

Under the POA guidelines, a condition that develops during an outpatient encounter before the inpatient order, including in the ED, in observation or during outpatient surgery, counts as present on admission.

Question 3

In MS-DRG terminology, what does 'MCC' stand for?

Accepted Answer

Major Complication or Comorbidity

Answer

An MCC (Major Complication or Comorbidity) is a secondary diagnosis that moves the case to the highest-severity, highest-paying DRG in its family. A CC is a lower severity tier.

Question 4

Under UHDDS, how is the principal diagnosis defined?

Accepted Answer

The condition established after study to be chiefly responsible for the admission

Answer

UHDDS defines the principal diagnosis as 'that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.'

Question 5

What happens to Medicare payment when a designated Hospital-Acquired Condition (HAC) is coded with POA indicator N?

Accepted Answer

The HAC cannot be used to assign a higher-paying MS-DRG

Answer

Under the CMS HAC/POA program, a selected HAC that was not present on admission cannot count as a CC/MCC to move the case into a higher-paying DRG.

ICD 10 Practice Test

ICD 10 Practice Test

ICD 10 Present on Admission (POA) Indicators and MS-DRG Reimbursement