Excite Health Partners

INPATIENT CODING: DEFINING ‘PRESENT ON ADMISSION’

Inpatient Coding: Defining ‘Present on Admission’

In today’s rapidly developing pay-for-performance healthcare environment, collection, quality, and interpretation of present on admission (POA) indicators continues to play a key role in the inpatient coder’s responsibilities.

What is POA?

POA is defined as a condition that is present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered to be POA.

Coding options

Providers must report one of five indicators:

• Y = yes (present at the time of inpatient admission)
• N = no (not present at the time of inpatient admission)
• U = unknown (documentation is insufficient to determine if condition was present at the time of admission)
• W = clinically undetermined (provider is unable to clinically determine whether condition was present on admission)
• 1 (on electronic claims) or blank (for paper claims) = exempt from POA reporting

The importance of documentation

Ideally, a physician works with hospital staff and coders to determine the best way to communicate POA information. POA indicators are assigned to principal and secondary diagnoses and external cause injury codes.  One recommendation is for physicians to simply put ‘POA’ in their notes next to their diagnosis. The Centers for Medicare and Medicaid Services (CMS) has suggested that the discharging physician clearly indicate in the discharge summary which of the conditions were or were not present on admission.

The Deficit Reduction Act of 2005 mandated that providers report POA indicators for all diagnoses submitted on Medicare inpatient acute care claims for discharges beginning October 1, 2007.  One year later, CMS announced that it intended to stop paying the costs of treating what it deemed to be preventable inpatient complications (Medicare No-Pay List).  This was a controversial move since the responsibility then fell to physicians and hospitals, not up to Medicare, to resolve documentation that is inconsistent, missing, conflicting, or unclear.

Like other coded data, the POA indicator is increasingly used for multiple purposes – reimbursement, clinical research, financial planning and quality of care evaluation. Successfully implementing POA reporting requires educating physicians and hospital staff on their roles in correct POA assignment.

If the coder encounters POA documentation that is unclear, they must query the provider. The physician is responsible for resolving the insufficiency.

Cynthia Alder-Smith, RHIT CCS

Auditor/ Educator Excite Health Partners

ADVISORY SERVICES: THE IMPORTANCE OF TECHNOLOGY AND STRATEGIC PLANS

Advisory Services: The Importance of Technology and Strategic Plans

Today, Advisory Services are becoming more prominent in the healthcare industry. Outside companies with experienced consultants offer organizations assistance with strategic initiatives and plans. Hospitals across the nation are creatively leveraging technology to offer more effective patient outcomes.

For example, Sentara Healthcare is working to advance the use of 3D printing. By utilizing the 3D printing technology, Sentara’s goal is to print an organ to allow doctors to assess the issues prior to surgery. University of Maryland Medical Center also is incorporating the latest technology into their medical advances – in April, the first organ delivery by drone was made to the hospital. Likewise, Hartford Hospital is leveraging advanced technology to assist with procedures. Hartford utilized 8 surgical robots to support heart, urological and gynecological surgeries and procedures.

Selecting the right outside help is key to utilizing the latest technology or developing a strategic plan/digital road map. Advisory consultants need to not only be knowledgeable of the latest technology but understand their impact in order to increase efficiency and patient outcomes. Understanding the benefits and impacts patient engagement have in an ACO model is an example of important aspects to consider when advising clients on initiatives and priorities.

Developing a strategic plan that supports a hospitals vision requires experienced consultants and fluid communication with the leadership of a hospital system.  Once a plan is finally developed, performing the system selection and portfolio management are paramount for patient and provider satisfaction.

The focus during Portfolio Management should on the core and strategic IT services needed by the healthcare system. This will help to support the IT Strategic plan over the next 3 to 5 years. The objective should be to reduce the number of applications allowing for a decrease in cost and increase in patient and user satisfaction.  

There are several different approaches for how a healthcare system can evaluate and select a vendor solution.  However, identifying the primary and secondary requirements is an important first step.  These requirements may include integration and storage capabilities, mobile device options, as well as features and functions within the application.  It’s vital to understand the strengths, weaknesses, opportunities and threats (SWOT) of each application within the healthcare system’s environment.

Through Excite’s Advisory Services, we can help your organization utilize the latest technology and develop a strategic plan to support the system. By evaluating current state environments, digital and automation initiatives, support models, project management offices and strategic plans, Excite works with you to develop each area to perform at their optimal level and provide guidance to your organization. 

Todd Klein

CIO, VP of EHR Services & Digital Solutions