Providers now facing scrutiny over quality will soon be given an added responsibility: documenting a patient’s condition at the start of the care process.
A significant change for healthcare organizations will be recognizing and coding a Present on Admission (POA) indicator for patients at the beginning of care episodes.
Under the Deficit Reduction Act of 2005, hospitals will be required to submit their claims with a POA code beginning Oct. 1, 2007, says Nelly Leon-Chisen, director of coding and classification for the American Hospital Association.
Some states, notably New York and California, already call for the use of a POA indicator. Under the DRA requirements, capture of POA codes will be nationwide.
The POA code is expected to help Medicare assess secondary diagnoses and devise payment rates for at least two diagnosis-related groups so that it doesn’t pay higher rates for post-admission infections, ostensibly because such infections result from substandard care.
The POA will help organizations better describe patient condition on admission, rather than relying on expensive chart abstraction on a patient-by-patient basis. However, capturing the POA as a byproduct of the admission process will require some adjustment.
Leon-Chisen is upbeat about the potential of the POA, saying it’s a step beyond existing ICD-9 codes, which don’t provide enough detail.
It will provide an additional coding challenge for hospitals, which will have to record data on the new UB-04 dataset and form from the National Uniform Billing Committee. The POA will be able to delineate between comorbidities, which are pre-existing conditions, and complications, which occur during the care process
The ICD-9 codes can’t do that.