Querying for POA

vdvaughn123vdvaughn123
in Clinical & Coding
Hello, I'm new to the forum but have been a CDIS for 10 years.  I currently work at a military hospital with one other CDI. I'm wondering if I should be querying more for POA diagnoses.  I don't query for POA for UTI/pyelo, encephalopathy, chest pain, abdnominal pain, etc.  It seems needless to me, but maybe I'm missing some queries that should be put out there.  Thanks in advance for the feedback.

Comments

  • afrady@blr.comafrady@blr.com
    One of the most important things for a coder in determining POA is careful consideration of the correct PDX.  If you are unsure of your POA status, the list of candidates for appropriate assignment as PDX under the UHDDS is altered significantly.   The more interesting focus however is on quality metrics across the board which you may be some what unaware of having come from a military hospital.  There are certain key diagnoses which when reported as not present on admission are considered to be a measure of poor quality of care on the part of the hospital and these present in a number of different quality metrics.    

    Just using the list above I could set up some hypothetical questions. (These are just hypothetical I could write a book here probably so this is just rough ideas).
    UTI/Pyelo.   If not present on admission then you also couldn't use it as the local infection for sequencing sepsis as pdx...Ie, if the local infection that caused sepsis was not POA, the sepsis cannot be POA either.
    Encephalopathy:  What was the reason for admission in the eyes of the doctor...were they really admitted for the simple UTI, or was the decision to write that admit order largely dirven by the presentation of the pt as confused and encephalopathic.  To be sure, some MDs will say it was the AMS that sealed the deal.
    Chest pain:   Do you need to go back and sequence a respiratory or GI condition as the PDX?  At that point reporting of chest pain is integral and not reported anyway.  If there was no determined etiology for the chest pain then I suppose there wouldn't be too much impact...other than the obvious question of wondering why a patient who had chest pain passed through the ER and initial admission without the MD ever bothering to mention the pt was having chest pain!!
    Abdominal Pain: Similar to the above comment although less life threatening.
  • vdvaughn123vdvaughn123
    Wow.  Thank you for your response.  I'm wondering though, does the provider HAVE to state these were present on admission, presented to ED with...   or can the Pdx be implied sometimes with what the treatment is steered toward or the diagnostics are aimed at.  Long ago I learned that just because a particular diagnosis appears as #1 on his assessment doesn't mean that is the Pdx. :o)
  • afrady@blr.comafrady@blr.com
    For infection codes that include the causal organism, assign “Y” if the infection (or signs of the infection) were present on admission, even though the culture results may not be known until after admission (e.g., patient is admitted with pneumonia and the provider documents Pseudomonas as the causal organism a few days later). You are correct.   What the provider lists as the first listed diagnosis will often not be selected by the coder as the pdx.  In some cases, the providers first listed diagnosis does not even meet UHDDS criteira for selection as the pdx so coders have to resort the sequencing based on the legal reporting definitions.  The provider does however (usually) have to state if a condition was POA in order for the coder to designate it as such, or it has to be very clearly present in the ED, H&P and/or initial progress note.

    There is one coding guideline which SHOULD allow coders some judgement here in the Present on admission guidelines of the OCG

    "Conditions diagnosed during the admission but clearly present before admission Assign “Y” for conditions diagnosed during the admission that were clearly present but not diagnosed until after admission occurred. 
     
    Diagnoses subsequently confirmed after admission are considered present on admission if at the time of admission they are documented as suspected, possible, rule out, differential diagnosis, or constitute an underlying cause of a symptom that is present at the time of admission"

    "For infection codes that include the causal organism, assign “Y” if the infection (or signs of the infection) were present on admission, even though the culture results may not be known until after admission (e.g., patient is admitted with pneumonia and the provider documents Pseudomonas as the causal organism a few days later)."

    However, i find very few coders willing to apply the "or constitute an underlying cause of a symptom that is present at the time of admission" as the sole determining factor in adopting the diagnosis as present on admission-Yes.   The need something a little more concrete.
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