Question

Under the Hospital Acquired Conditions provision of the IPPS, the Secretary of Health and Human Services has designated several conditions that, when acquired during a hospital admission, have the potential to reduce MS-DRG payment. One of the conditions applicable for FY 2015 are Pressure Ulcers (ICD-10-CML89.X) codes. To identify if the pressure ulcer was present when the patient was admitted or was acquired during the hospital stay, the hospital must report a present on admission code for each diagnosis on the UB-04 form.

Scenario: Stephanie is the coding manager at Anywhere Hospital. The coders have been charged with applying the present on admission indicator code. Stephanie has collected data over the past six months. It is quite clear from the data that there is an issue with either the documentation of pressure ulcers, assignment of the POA indicator, or the quality of care provided at Anywhere Hospital. Stephanie has requested that Sally, one of the Quality Managers, assist her with this issue.

POA Report for Pressure Ulcers (L89.X) October - March
POA Code	Description	Volume
Y	Yes, present on admission	15
N	No, not present on admission	30
U	Unknown, insufficient documentation	45
W	Clinically undetermined	3
1	Exempt from POA reporting	0

It is clear that a medical record audit is necessary to determine if there is a documentation, POA assignment, or quality of care issue. Design an audit plan for this issue.

The Audit Plan must address the following:

1. What questions should be asked?
2. What processes need to be examined?
3. Who should conduct the audit?
4. How will you address educating physicians on documentation?
5. How will you educate coders on how to work with physicians with the documentation process?
6. What team members should be involved to address the issue?

Answer 1

1. The questions which can be asked for audit are

*How often do the pressure are to be looked into.

*skin care in details with lotion, creams

* type of clothing to the hospitalised patients

* what is the diet to prevent the ulcers and hel9 in faster healing

* ways to keep the ares wise clean  

2. The process which can be processed are the infection control management, water and drainage, patients history

3. Auditors internal from institution and with the outsiders

4. The physicians can be addressed to education on documentation by:

* document training session

* provide ongoing process and performance monitoring and support.

5. Training group activity and attending the training classes

6. Anyone and from site side who ever has taken the chapter.