How to Code for Hospital-Acquired Conditions (HACs)

Hospital-acquired conditions (HACs) are medical issues that a patient develops during a hospital stay, which were not present at the time of admission. Properly coding HACs is crucial for compliance, quality reporting, and accurate reimbursement. The Centers for Medicare & Medicaid Services (CMS) has implemented policies that reduce payment for certain HACs, emphasizing the importance of correct documentation and coding practices.


Understanding HACs

HACs can include a variety of conditions such as catheter-associated urinary tract infections (CAUTIs), pressure ulcers, surgical site infections, and falls. These conditions are preventable with proper hospital care. CMS publishes a list of HACs that are subject to payment penalties if acquired during the hospital stay and not present on admission (POA).


Importance of Present on Admission (POA) Indicator

The POA indicator is key in distinguishing whether a condition was present when the patient was admitted or developed during the hospital stay. Coders must assign the correct POA value using indicators such as:

Y – Yes, present on admission

N – No, not present on admission

U – Unknown

W – Clinically undetermined

The accuracy of the POA indicator directly impacts hospital reimbursement and quality metrics. If a condition is not coded as POA and is on the HAC list, it may result in non-payment from CMS.


Documentation and Coding Guidelines

Review Clinical Documentation: Ensure documentation clearly states whether the condition was present at the time of admission. If unclear, coders should query the provider for clarification.

Apply ICD-10-CM Codes: Use the correct ICD-10-CM codes for the specific HAC. Pair them with the POA indicator to accurately reflect the timing of the condition.

Follow Official Guidelines: Refer to the ICD-10-CM Official Guidelines for Coding and Reporting, especially Section II (Selection of Principal Diagnosis) and Section III (Reporting Additional Diagnoses).

HAC Reduction Program Awareness: Coders should stay updated on CMS’s HAC Reduction Program, which affects payment for hospitals in the lowest-performing quartile of HAC measures.


Common Challenges

Inconsistent Documentation: When providers use vague terms like “appears to be,” coders may be unable to confidently assign a POA indicator.

Delayed Diagnoses: Conditions not documented until after admission may still be POA if clinical indicators were present. Accurate chart review is essential.

Communication Gaps: Lack of collaboration between providers and coders can lead to underreporting or misclassification.


Best Practices

Educate providers on the significance of POA documentation.

Implement clinical documentation improvement (CDI) programs.

Use coding audits to identify and correct errors.

Regularly train coding staff on HAC policies and changes in CMS guidelines.


Conclusion

Coding for hospital-acquired conditions requires accuracy, attention to detail, and collaboration between coders and clinical staff. Proper documentation and the correct assignment of POA indicators ensure compliance, improve patient safety reporting, and prevent revenue loss. With a strong focus on preventing HACs, accurate coding plays a vital role in healthcare quality and accountability.

Learn : Medical Coding Training Course

Read More : How to Write Effective Queries for Physicians

Read More : How to Handle Denied Claims Due to Coding Errors

Read More : Understanding Medical Necessity in Coding


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