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Hospital-Acquired Conditions (Present on Admission Indicator)

Hospital-Acquired Conditions

Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify, by October 1, 2007, at least two conditions that are (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines. 

In August 2007, CMS published the FY2008 Inpatient Prospective Payment System (IPPS) Final Rule.  The Final Rule introduced three different categories of conditions that, when present, trigger a higher payment as either a complicating condition (CC) or major complicating condition (MCC):

 

Category

Conditions

Conditions selected for implementation

  • These conditions will have payment implications beginning in October 1, 2008.

 

  • Serious Preventable Events
    • Object left in during surgery (998.4 CC)
    • Air embolism (999.1 MCC)
    • Blood incompatibility (999.6 CC)
  • Catheter Associated Urinary Tract Infection, 996.64 CC & one of the following specific infection codes: 112.2, 590.10, 590.11, 590.2, 590.3, 590.81, 590.89, 590.9, 595.0, 595.3, 595.4, 595.81, 590.89, 595.9, 597.0, 597.80, 599.0
  • Pressure Ulcers (707.00-.01 & 7-7.09 CCs; 707.02-09 MCCs)
  • Vascular Catheter Associated Infection (999.31 CC)
  • Surgical Site Infection – Mediastinitis after Coronary Artery Bypass Graft (CABG) Surgery (519.2 MCC & 36.10-.19)
  • Falls and Trauma – Fractures, Dislocations, Intracranial Injuries, Crushing Injuries, and Burns (Codes will be considered in FY2009 IPPS Proposed Rule)

Conditions being considered for FY2009 IPPS rulemaking

  • These conditions raise one or more implementation or policy issues that need to be resolved before they can be selected.  CMS will work to address these issues and propose to reconsider these conditions during the FY 2009 IPPS rulemaking process.
  • Ventilator Associated Pneumonia (VAP) (Codes will be considered in FY2009 IPPS Proposed Rule)
  • Staphylococcus Aureus Septicemia (038.11 + 995.91, 998.59, 999.3 MCCs)
  • Deep Vein Thrombosis (DVT)/ Pulmonary Embolism (PE) (DVT: 453.40-.42 CCs; PE: 415.11 & 415.19 MCCs)

Conditions needing further analysis

  • After exhaustive consideration, CMS determined that further analysis is required before considering these conditions.

 

  • Methicillin Resistant Staphylococcus Aureus (MRSA) (Codes will be considered in FY2009 IPPS Proposed Rule)
  • Clostridium Difficile-Associated Disease (CDAD) (008.45 CC)
  • Wrong Surgery (Codes will be considered in FY2009 IPPS Proposed Rule)

 

 

 

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Page Last Modified: 01/30/2008 4:30:00 PM
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