A patient undergoes total knee replacement.

CMS's Hospital-Acquired Condition payment provisions include DVT and pulmonary embolism following certain orthopedic procedures, including qualifying hip and knee replacement cases. Consequently, accurate POA determination is important when a DVT occurs during the hospitalization.

If a qualifying HAC diagnosis was not present on admission, CMS's MS-DRG payment methodology may prevent the condition from generating the higher payment that its CC/MCC status would otherwise produce, subject to applicable grouper rules.

The diagnosis is still coded. Hospital-acquired status does not mean the condition disappears from the medical record or claim. The purpose of HAC payment logic is to modify payment treatment for defined conditions rather than suppress their reporting.

Nor does a single qualifying HAC necessarily eliminate the entire hospital payment. It affects how the MS-DRG is calculated in accordance with CMS rules.

CDI specialists should also distinguish the HAC/POA payment provision from the separate HAC Reduction Program. CMS explicitly identifies HACRP as a separate quality-payment program.

CCDS Reference Topics: DVT; orthopedic procedures; POA; HAC payment adjustment; MS-DRG.

=========