Assigning a POA indicator for pressure ulcers that progress from one stage to the next during a hospital stay
HIM Connection, November 18, 2008
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Q: What present on admission (POA) indicator should we assign when a patient presents to the hospital with a stage I pressure ulcer (code 707.21) that later develops to a stage III pressure ulcer (code 707.23) during his or her stay? Will CMS consider the stage III ulcer a hospital acquired condition (HAC)?
A: According to Sue Bowman, RHIA, CCS, director of coding policy and compliance for the American Health Information Management Association in Chicago, CMS does not currently consider a condition an HAC when it is POA but progresses during the hospitalization. CMS intends to limit the HAC payment provision entirely to conditions that develop during the hospitalization. According to the ICD-9-CM Official Guidelines for Coding and Reporting, coders must code only the highest stage of an ulcer present upon admission. Therefore, for the scenario presented above, report code 707.23 with POA indicator of Y. Refer to the upcoming Coding Clinic, 4th quarter, for more information.
Editor's note: Shannon McCall, RHIA, CCS, CPC, director of coding and HIM at HCPro, Inc., gathered information related to this answer.
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