Question

76- year- old morbidly obese white male , was admitted to facility with acute exacebration of COPD. He is a previous smoker, but has not smoked for the past year because of his breathing issues have continued to worsen. He was started on oxygen and treated with an oral corticosteroid with prophyalatic antibiotics administred. The
progress note of day two states that the pressure ulcer of his right heel (stage 4) was
non- excisional debrided at bed side.
As an auditor, you review the POA status, code assignment, and DRG assignment shown below for this patient stay

J44.1......Y(present on admission)
L89.614.....N
E66.01.........Y
Z87.891.......E(exempt)

1) what is the error, all the POA assignment is correct and what impact on the does on the reimbursement?

4.22 HAC-POA Subdomain IV.A.1 Apply policies and procedure for the use of data que healthcare reimbursement Subdomain IV.A.1 Manage the use of clinical data required by various payment and reimbursement systems exacerbation of COPD. He is a previous because his breathing issues have conti treated with an oral corticosteroid with note of day two sites that the pressure debrided at the bedside As an auditor, you review the POAS year old morbidly obserw a was B itted to the facility with D. He is a previo mokev, but has not smoked for the past year ng issues have continued to worsen. He was started on Oxy and corticosteroid with prophylactic antibiotics administered the pre S that the pressure ulcer of his right heel (stage A) Was Tion-excisionally You review the TOA status codesignment, and DRGs ment shown below for this patient's stayYOL conclude there is an em at is the error, and what impact does it have on reimbursement? action might need to be taken to justify your conclusion of a coding error? 1. What is the error, and DRG assignment 192 POA status ICD-10-CM codes assigned 144.1 L89.614 E66.01 287.891

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  1.coding N. it is the error. for hospital acquired condition reimbursement is not given.

  2. It should be immediately reported . The patient is having arterial insufficiency and mistaken for pressure ulcer. code must be changed. otherwise reimbursement is not given to the client.

Answer 1

1.Error i seen in these case is not coded for the non-excisional debridement it is non operative brusing,scrubbing of devitalizes tissues,necrosis or other foreign material.Code assigned for the non-excisional debridgement is 86.28.

• Coding N:It indicate not present at the time of inpatient admission.Pressure ulcer at the right heel was seen on the admission of day two that results it is hospital acquired condition.
• For hospital acquired condition reimbursement should not be provided or given.

2.The action to be taken that non excisional debridgement should be reported immediately and send for reimbursement.The ulcer is formed due to decreased blood supply that is arterial insufficiency that code has to be changed to Code I73.9.If you not take necessary action reimbursement should not be provided to the patient.