Inpatient Facility Coding & Compliance Alert

Question: Mr. Michael, 55, was admitted to the hospital with acute atrial fibrillation. During his hospital stay, he happened to develop a decubitus ulcer on the buttock What DRG can we assign to this patient, given that the decubitus ulcer was not present on admission?

Minnesota Subscriber

Answer: At a first glance this case seems to be of atrial fibrillation with a CC, and comes under the MDC 05- category of diseases and disorders of the circulatory system. However, since the ulcer was not present on admission or at least documented as POA, CMS would calculate the case as if this CC does not exist and it would be suitable case for the DRG 310 (Cardiac arrhythmia & conduction disorders W/O CC/MCC). Despite the fact that the patient now has a CC of 707.05 (Pressure ulcer, buttock), do not make the mistake of assigning the DRG 309 (Cardiac arrhythmia & conduction disorders W CC), as the condition was not present on admission. In fact, pressure ulcer was acquired during hospital stay and CMS will consider it Hospital Acquired Condition (HAC) and would not help getting additional reimbursement even if it was present during the stay in the hospital.

Remember: Assign the DRG 310 to this case and make sure to fill the indicator field specifically designed for POA assignment on the UB-04 form. POA indicators for this case would be:

• 427.31 (Atrial fibrillation) – POA indicator Y

• 707.05 (Pressure ulcer, buttock) – POA indicator N

Here are the descriptions of POA indicators you may find useful:

• Y/Yes: Present at the time of admission to hospital

• N/No: Not existing at the time of admission to hospital.

• U/ Unknown: Insufficient documentation for the coder

• W/ Clinically Undetermined: Provider not able to clinically determine the presence or absence of the condition on admission.