As part of the POA Indicator Reporting Requirement, CMS has identified a list of possible diagnoses that will limit an organization’s ability to receive higher diagnosis-related group (DRG) payments. Starting October 1, 2008, claims with the following conditions that are not designated as present on admission and that do not have any other reason for qualifying for the higher paying DRG, will not be reimbursed at the higher level:
- Serious preventable event, object left in surgery
- Serious preventable event, air embolism
- Serious preventable event, blood incompatibility
- Catheter-associated urinary tract infection
- Pressure ulcers (deceits)
- Vascular catheter-associated infection
- Mediastinitis after cardiac artery bypass grafting-surgical site infection
- Hospital-acquired injuries (fractures, dislocations, intracranial injury, crushing injury, burn, and other unspecified effects of external causes)
For example, if a patient develops a urinary tract infection during an inpatient stay, and that infection is the only reason the claim qualifies for a higher-paying DRG, CMS will not reimburse at the higher level. If, however, the patient has diabetic ketoacidosis as well as his or her primary condition, and the diabetic ketoacidosis was present on admission, then the claim would qualify for the higher paying DRG even if a hospital-acquired urinary tract infection was present.