Present on Admission Indicators (POAs), Hospital Acquired Conditions (HACs): What's the Bottom Line? Do They Really End Up Affecting the Assigned MS-DRG?  

Category: Coding

Imagine this scenario: You are a 70-year old Medicare patient who is extremely active and healthy (i.e., no co-morbid conditions). By virtue of being overactive, you've developed arthritis. You've just had a right total knee replacement performed two days ago and other than some expected pain, you seem to be doing just fine. But while relaxing watching TV in your hospital bed, you develop severe shortness of breath and call for the nurse immediately. The surgeon is called and you are subsequently diagnosed with a postoperative pulmonary embolism directly related to the knee replacement.

Although, this scenario seems like one that may not happen frequently, these types of conditions that develop solely while in a hospital setting (i.e. hospital acquired) do occur -- and cost payers billions of dollars each year. Payers and healthcare organizations alike are able to identify such...