Under the Hospital-Acquired Conditions provision of the IPPS, the Secretary of Health and Human Services has designated several conditions that when acquired during a hospital admission have the potential to reduce MS-DRG payment. One of the conditions applicable for FY 2012 is pressure ulcers (ICD-9-CM code 707.0X). To identify 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 each diagnosis on the UB-04 form.

Scenario: Stephanie is the coding manager at Anywhere Hospital. The coders have been charged with applying the present on admission indicator code. Stephanie has collected data over the past six months. 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 Anywhere Hospital. Stephanie has requested that Sally, one of the quality managers, assist her with this issue.

It is clear that a medical record audit is necessary to determine if there is a documentation, POA assignment or quality of care issue.

Design an audit plan for this issue. What questions should be asked? What processes need to be examined? Who should conduct the audit?