Assignment
Mr. Cline is a 76-year-old morbidly obese white male admitted to ABC Hospital as an Inpatient with Acute COPD exacerbation on 07/29/2022.
He has been a previous smoker for 55 years but has not smoked in over a year because his breathing issues continue to worsen.
Upon admission, he was started on oxygen therapy and treated with oral corticosteroid with prophylactic antibiotics.
The progress note dated 07/30 states a pressure ulcer on his right heel, stage 4. On the same day, this ulcer was non-exceptionally debrided at his bedside.
Diagnosis Codes for Mr. Cline show up on his claim as follows:
• J44.1 with a POA indicator of Y
• L89.614 with a POA indicator of N
• E66.01 with a POA indicator of Y
• Z87.891 with a POA indicator of U
The DRG on the claim is 192
As the Coding Auditor for ABC Hospital, this case shows up on one of your monthly POA audits. Your audit findings indicate opportunities with the Coding for this encounter (1 or more errors). There are also coding process opportunities for the coder and documentation opportunities for the provider(s) who treated Mr. Cline.
As the Coding Auditor, you will need to provide detailed information about the audit findings and educate the providers, coders, and billers about cases such as this one.
Remember that the coder assigns the POAs on encounters based on documentation in the record - what are the opportunities for the coder based on your findings?
HINT: Consider researching the etiology of Pressure Ulcers and the length of time it takes to develop a Pressure Ulcer.
A. Explain the POA guidelines (in Detail) that you used to perform this audit. What are the definitions of POA, and when/how should they be used?
B. Determine any error(s) for POA assignment in this case. For each error, explain the contributing factors that appear to have led to the coder's decision on the POA assignment.
C. Explain what the coder could have (should have) done differently to avoid POA assignment errors.
D. Explain how the POA assignment affected the DRG and what is the impact on reimbursement?
E. What Impact might this have on the patient?
F. This claim has been sent to the Payor; what actions (if any) need to be taken for this claim? Who would conduct the activities?
G. How would this POA Assignment affect the reporting of quality data, the reporting of Health Care Acquired Conditions (HACs), and quality measures for the organization?
H. How do cases like this, where the claim has already been sent out, affect the Revenue Cycle? Be sure to include how certain areas of RCM are affected.