HACs set for October 1: Are you ready?
When a hospital-acquired-condition (HAC) is not present on admission (POA), and it is the only complication/comorbidity (CC) or major CC (MCC) on the claim, the case will group to a lower-weighted Medicare Severity DRG (MS-DRG). That means less reimbursement for your hospital.
“It could have a financial impact on the hospital’s bottom line,” says DeAnne W. Bloomquist, RHIT, CCS, a coding and compliance consultant and the president of Mid-Continent Coding, Inc., in Overland Park, KS.
The following eight HAC conditions take effect October 1:
- Foreign object retained after surgery. Codes 998.4 (foreign body accidentally left during a procedure) and 998.7 (acute reaction to a foreign substance accidentally left during a procedure) denote this HAC.
- Air embolism. Code 999.1 (air embolism to any site, following infusion, perfusion, or transfusion) denotes this HAC that refers to a condition in which air inadvertently passes through an open blood vessel.
- Blood incompatibility. Code 999.6 (ABO incompatibility reaction) denotes this HAC.
- Stages III and IV (decubitus) pressure ulcers. Code 707.23 indicates a stage III decubitus ulcer, and code 707.24 indicates a stage IV decubitus ulcer.
- Falls and trauma. This includes fractures, dislocations, intracranial injuries, crushing injuries, and burns. The following codes denote this HAC:
- Codes 800–829: Fractures
- Codes 830–839: Dislocations
- Codes 850-854: Intracranial injuries
- Codes 925–929: Crushing injuries
- Codes 940–949: Burns
- Codes 991–994: External causes (i.e., heat, air pressure, light, frostbite)
- Catheter-associated urinary tract infections (UTI). Code 996.64 (infection due to indwelling urinary catheter) denotes this HAC.
- Vascular catheter-associated infections. Code 999.31 (infection due to central venous catheter—catheter-related bloodstream infection, not otherwise specified) denotes this HAC.
- Mediastinitis after coronary artery bypass graft (CABG). Code 519.2 (mediastinitis) and a CABG procedure code from the 36.10–36.19 range denote this HAC.
For more information on HACs, visit www.cms.hhs.gov
To listen to the HCPro, Inc., audio conference “POA Reporting for Hospital Acquired Conditions: Strategies to Obtain Complete Documentation,” visit www.hcmarketplace.com.
To read the complete article ” Don’t let HACs cut into your bottom line“, visit the ACDIS Web site’s Helpful Resources section.
About the Author: Melissa Varnavas, CPC, ACDIS associate director, editor for CDI Strategies, CDI Journal. She has several writing awards from various newsletter and newspaper organizations.
Melissa Malabanan | Sep 17, 2009 | Reply
Hello my friend and namesake.
I was reading your article re: HACs– I do understand that this took effect October 1, 2008- this is from CMS website:
Per CMS website there are also 10 HAc conditions,
I may be reading wrong, can you clarify above article? Thanks
The 10 categories of HACs include:
Foreign Object Retained After Surgery
Air Embolism
Blood Incompatibility
Stage III and IV Pressure Ulcers
Falls and Trauma
Fractures
Dislocations
Intracranial Injuries
Crushing Injuries
Burns
Electric Shock
Manifestations of Poor Glycemic Control
Diabetic Ketoacidosis
Nonketotic Hyperosmolar Coma
Hypoglycemic Coma
Secondary Diabetes with Ketoacidosis
Secondary Diabetes with Hyperosmolarity
Catheter-Associated Urinary Tract Infection (UTI)
Vascular Catheter-Associated Infection
Surgical Site Infection Following:
Coronary Artery Bypass Graft (CABG) – Mediastinitis
Bariatric Surgery
Laparoscopic Gastric Bypass
Gastroenterostomy
Laparoscopic Gastric Restrictive Surgery
Orthopedic Procedures
Spine
Neck
Shoulder
Elbow
Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
Total Knee Replacement
Hip Replacement
Payment implications will begin October 1, 2008, for these 10 categories of HACs.
Wendy Clesi | Sep 23, 2009 | Reply
The 10 categories of HACs went into effect October 1, 2009. No additional conditions will be added for 2010.
The 10 categories of HACs include:
1. Foreign Object Retained After Surgery
2. Air Embolism
3. Blood Incompatibility
4. Stage III and IV Pressure Ulcers
5. Falls and Trauma
– Fractures
– Dislocations
– Intracranial Injuries
– Crushing Injuries
– Burns
– Electric Shock
6. Manifestations of Poor Glycemic Control
– Diabetic Ketoacidosis
– Nonketotic Hyperosmolar Coma
– Hypoglycemic Coma
– Secondary Diabetes with Ketoacidosis
– Secondary Diabetes with Hyperosmolarity
7. Catheter-Associated Urinary Tract Infection (UTI)
8. Vascular Catheter-Associated Infection
9. Surgical Site Infection Following:
– Coronary Artery Bypass Graft (CABG) – Mediastinitis
– Bariatric Surgery
– Laparoscopic Gastric Bypass
– Gastroenterostomy
– Laparoscopic Gastric Restrictive Surgery
– Orthopedic Procedures (Spine, Neck, Shoulder, Elbow)
10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
– Total Knee Replacement
– Hip Replacement
Payment implications will begin October 1, 2008, for these 10 categories of HACs.
See the CMS Web site for more details: http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp#TopOfPage
Melissa Varnavas | Sep 23, 2009 | Reply
Thanks for the clarification Wendy. Much appreciated.
Here’s a link to the CMS IPPS 2010 Final Rule Page
Here’s a recent article that ran in Briefings on Coding Compliance Strategies
The Case Management Blog also offers a post…