Tuesday, May 26, 2009

How to Use POA


As yoyu know, DRG versions 25 and up require the use of the Present On Admission (POA) indicator associated with ICD9 diagnosis codes for the grouping of DRGs. Your grouper software does support versions 25 and 26, but no where in your documentation do I find any reference to POAs and how they should be fed into the data file, or defined in the control file.

We need this information asap in order to ensure that the grouper is working correctly. Please email or call me at your earliest convenience.


Please find attached our most recent documentation, which has a healthy entry in the Index under POA.

I am not sure which of our products you are using, but POA should be supported across the product line. To quote the docs on POA support in general:

Note: as of version 26, released in 2008, the DRG version can have either
a 'p' or an 'e' or both appeneded to it. If there is a trailing 'p', it
is assumed that the last character of every diagnosis code is a POA flag.
If the there is a trailing 'e', then the source institution is presumed
to be exempt from the HAC. Thus "26p" specifies POA support, while "26"
does not. "25p" does not make sense.

To quote the glossary on POA:
In order to avoid paying for medical mistakes, diagnoses are now
flagged as having been present on admission (POA).

The values for the POA flag are not, as one might expect, simply
Y or N; rather the following options are defined:

-Y for Yes
-N for No
-U for Unspecified
-W for clinically undetermined
-1 for unreported / not used / exempt from reporting
To quote from Chapter 5, on our DRGFilt product:
The keyword "poa " specifies where, in the diagnosis code, to find the
POA flag. If the diagnosis code length (specified by dlx) is 8, it is
typical to find the POA flag at offset 7, that is to say the last character
of every code.

The keyword "exmp" specifies that the institution from which these data
come is exempt from the HAC.

Note that if neither of these keywords is present, the software assumes that
POA is irrelevant and that the source institution is to be treated as exempt
from the HAC.