Developing an Audit Plan (Level 6 - Creating)

Instructions

The Hospital-Acquired Conditions Present on Admission (POA) Program designates diagnosis and procedures that are considered preventable in the inpatient setting. One condition applicable for FY 2018 is Stage III and Stage IV pressure ulcers (ICD-10-CM codes in category L89). To indicate whether the pressure ulcer was present when the patient was admitted or was acquired during the hospital stay, the hospital must report a present on admission code for L89 diagnosis codes on the claim form. Hospitals with HAC may have reimbursement for the admission decreased. Review figure 10.5 in the textbook.

Scenario: Stephanie is the coding manager at Happy Hospital. The coding professionals have been charged with applying the POA indicator code. Stephanie has collected data over the past six months for stage III and stage IV pressure ulcers. It is quite clear from the data that there is an issue with either the documentation of pressure ulcers, assignment of the POA indicator, or the quality of care provided at Happy Hospital.

POA Report for Pressure Ulcers (L89.x) October - March
POA Code	Description	Volume
Y	Yes, present on admission	15
N	No, not present on admission	30
U	Unknown, insufficient documentation	45
W	Clinically undetermined	3
I	Exemption form POA reporting	0

Design an audit plan for this POA issue. When designing your audit consider the following questions to help you determine components that should be incorporated in your plan:

What is the scope of the audit?

What are the goals of the audit?

What processes need to be evaluated?

What data should be collected during the audit?

What data will determine if this is a documentation issue?

What data will determine if this is a POA assignment issue?

What data will help you determine if this is a quality of care issue?

Who should be on the audit team to conduct the audit?

What rules/guidelines should be considered?

HINT see Official Coding Guidelines Appendix I, Present on Admission Reporting Guidelines and Official Coding Guidelines, Section I, C, Chapter-Specific Coding Guidelines, Chapter 12, Diseases of the Skin and Subcutaneous Tissue (L00-L99).