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

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

Answer: Y

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.

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

Answer: Present on admission (Y)

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.

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

Answer: Major Complication or Comorbidity

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.

Under UHDDS, how is the principal diagnosis defined?

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

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.'

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

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

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.

Which of these does NOT directly affect MS-DRG assignment?

Answer: Attending physician's specialty

The MS-DRG grouper uses principal diagnosis, secondary diagnoses (CC/MCC), procedures, discharge disposition, age and sex. The physician's specialty plays no part.