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Administrative Memo

News

Present On Admission Indicator
Effective October 1, 2007, The HAC provisions in Medicare regulations required hospitals to begin reporting on their Medicare claims on October 1, 2007, whether certain specified diagnoses were present when the patient was admitted. The first eight conditions, which were selected last year because they greatly complicate the treatment of the illness or injury that caused the hospitalization, resulting in higher payments to the hospital for the patient's care by both Medicare and the patient, were:

Object inadvertently left in after surgery
Air embolism
Blood incompatibility
Catheter associated urinary tract infection
Pressure ulcer (decubitus ulcer)
Vascular catheter associated infection
Surgical site infection- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
Certain types of falls and trauma

CMS is proposing to expand the list of conditions that need to be reported if present when a patient is first admitted. The list in the proposed rule includes:

Surgical site infections following certain elective procedures
Legionnaires' disease (a type of pneumonia caused by a specific bacterium)
Extreme blood sugar derangement
Iatrogenic pneumothorax (collapse of the lung)
Delirium
Ventilator-associated pneumonia
Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
Staphylococcus aureus septicemia (bloodstream infection)
Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

Beginning October 1, 2008, Medicare will no longer pay the hospital at a higher rate for the original eight conditions or any conditions added to the list in the final rule, if they were acquired during the hospital stay. For more information, please visit:

http://www.cms.hhs.gov/transmittals/downloads/R289OTN.pdf

IPPS Proposed Rule 2009; Federal Register, CMS 1390 P

April 30, 2008

MedLearnMatters MM5499: Issued 5/11/07, Revised 8/15/07, 9/6/07, 9/11/07, 6/16/08

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5499.pdf

All guidelines are not inclusive. The coder should refer to the applicable Coding Clinic guidelines for additional information. The Centers for Medicare & Medicaid Services considers Coding Clinic, published by the American Hospital Association, to be the official source for coding guidelines. Hospitals should follow the Coding Clinic guidelines to assure accuracy in ICD-9-CM coding and DRG assignment.

The Coding guidelines on IPRO's Coding Corner and HPMP Web sites are designed to assist hospitals in achieving coding consistency and accuracy. IPRO updates these guidelines as needed to reflect changes in federal and state regulations. The coding guidelines are not all inclusive and in the event that these guidelines contradict coding clinic directives then the coding clinic directives are to be adhered to (i.e., as issued by the Cooperating parties, American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers for Medicare & Medicaid Services (CMS) and National Center for Health Statistics (NCHS)).